West Africa Journal of Medicine

REVIEW ARTICLE: Chronic Complications of Diabetes Mellitus

R. N. Oputa — 2024-08-30

Background: This review article describes the chronic complications of diabetes mellitus (DM). The chronic complications of DM are diverse, often progressive and difficult to manage or reverse.

Objective: The aim of this review is to highlight the current concepts in the pathogenic mechanisms of the chronic complications of diabetes mellitus, with a view to educate doctors and specialists on the management of these problems. Timely referral to the multidisciplinary team of each medical facility and tertiary health institutions is encouraged.

Methods: The review of existing literature in the past fifty years and the management of diabetic patients in the past thirty years as a specialist and research scholar.

Conclusion: The molecular mechanisms in the chronic complications of DM are described in this review article. These includes the microvascular and macrovascular changes that occur in DM over many years. Also, the neuropathies are explained. The organ/system specific complications include: cardiovascular, renal, neurological, eye disease, skin changes, and diabetic foot syndrome.

EDITORIAL: From Prevention to Early Diagnosis: Tackling Acute Kidney Injury in Children, and Other Critical Health Challenges

G. E. Erhabor — 2024-08-30

With great enthusiasm, we bring you another edition of the journal in furtherance of the mission of showcasing the exceptional work of medical researchers, practitioners, and thought leaders from West Africa and beyond. We continue to provide a platform for evidence-based research and insightful contributions aimed at advancing medical knowledge, informing clinical practice, and inspiring strategies that improve healthcare outcomes across the region and beyond.

The articles featured in this edition span various topics and address critical health challenges across diverse fields, offering meaningful contributions to the ever-expanding body of knowledge. These studies reflect the rigorous efforts of the authors and the spirit of collaboration within the medical community toward improving healthcare delivery and patient outcomes. In their study, Odoh et al. demonstrated the superiority of a monthly sulphadoxine-pyrimethamine regimen over the standard two-dose schedule in reducing malaria-related maternal and neonatal complications. Adewolu and colleagues highlighted the diagnostic value of alpha-fetoprotein and other biomarkers in the early detection of hepatocellular carcinoma, while Emmanuel et al. emphasized the continued relevance of liver biopsies for detailed histological assessments despite the increasing availability of FibroScan facilities.

In a study from Southwestern Nigeria, Odunlami et al. reported an evolving pattern of rheumatic diseases, with a rise in inflammatory conditions like systemic lupus erythematosus and rheumatoid arthritis in the study area. The findings contrast with the previously reported predominance of degenerative diseases in earlier studies from the region.1,2 Oyedeko and co-workers reported that bacterial vaginosis remains a significant health concern among pregnant women and key risk factors identified include low education levels, frequent coitus, douching, obesity, and HIV infection. The pivotal role played by level of education suggests the need for relevant health educational interventions especially during antenatal care, including novel measures such as mHealth interventions that have been to be potentially impactful.3

I would like to further highlight the work by Okafor et al which underscored the potential of neutrophil gelatinase-associated lipocalin (NGAL) as an early biomarker for acute kidney injury in children with severe malaria. Acute kidney injury (AKI) is a critical health issue among children, especially in low-resource regions like ours, where access to renal replacement therapy is limited and healthcare expenses are predominantly out-of-pocket. Severe malaria exacerbates this burden, increasing the risk of chronic kidney disease (CKD), especially when care is delayed. Neutrophil Gelatinase-Associated Lipocalin (NGAL) is an emerging biomarker for early AKI detection. NGAL is a small protein expressed in various tissues, including the kidney, and is rapidly released into the bloodstream and urine in response to kidney injury. Unlike serum creatinine, which reflects functional impairment and may take days to rise, NGAL levels increase within hours of injury, offering a more timely indication of kidney stress or damage (3). NGAL not only enables early detection but also provides insights into the severity of injury and risks of progression. This is especially valuable for paediatric populations with severe infections like malaria, where timely intervention can prevent irreversible kidney damage.4,5

Research continues to explore NGAL’s role in clinical practice, aiming to refine its application in routine diagnostics and therapeutic decision-making. This was the focus of the study conducted by Okafor and colleagues in tertiary centres in Enugu, Nigeria. The findings reveal that NGAL predicts AKI earlier and more effectively than traditional serum creatinine measurements, underscoring its potential role in improving patient outcomes through timely interventions. The study also sheds light on the relationship between parasite density, NGAL, and renal impairment, with implications for developing targeted management protocols. Despite limitations such as a small sample size, the research advocates for the integration of NGAL testing into clinical practice, aiming to reduce the progression of AKI and associated mortality in children with severe malaria. This study underscores the urgent need for enhanced preventive measures, early detection strategies, and accessible interventions to mitigate the dual burden of malaria and kidney injury in vulnerable paediatric populations.

We appreciate the authors for their contributions. We also remain grateful to our reviewers and other stakeholder for their continued support and service. As we continue our mission to promote medical knowledge and innovation, the journal remains committed to providing a vibrant platform for researchers, clinicians, and thought leaders to share their findings with the global medical community. However, we have observed a decline in article submissions in recent months, and we believe it is crucial to reaffirm the value of publishing your work in this esteemed journal. We encourage submissions from all fields of medicine, including original research, clinical studies, systematic reviews, and case reports. Submissions from early-career researchers are also welcome, as the journal provides a supportive environment to showcase emerging talent. Publishing with the West African Journal of Medicine ensures broad dissemination among regional and international audiences. We urge authors to seize this opportunity to amplify their voices and share their contributions to healthcare. Together, let us strengthen the journal’s role as a beacon of scientific excellence. We eagerly await your submissions and look forward to showcasing your work in upcoming editions.

REFERENCES

Olufemi A, Hakeem OB, Olalade WK, Sunday OO, Oluwole AO. Epidemiology of rheumatic and musculoskeletal diseases in a Nigerian peri-urban community: results of a cross-sectional survey using the COPCORD stage 1 model. Reumatologia. 2022;60(6):366.
Oguntona SA, Edunjobi AS, Olatunde AO. Prevalence of rheumatic diseases in a rheumatology outpatient practice of a tertiary hospital. International Research Journal of Medicine and Biomedical Sciences. 2016;1(2):11-18
Olajubu AO, Fajemilehin BR, Olajubu TO. Mothers’ experiences with mHealth intervention for postnatal care utilisation in Nigeria: a qualitative study. BMC Pregnancy and Childbirth. 2022;22(1):843
Cho SY, Hur M. New Issues With Neutrophil Gelatinase-associated Lipocalin in Acute Kidney Injury. Annals of Laboratory Medicine. 2023;43(6):529-30.
Solarin A, Oguokiri E, Disu E, Njokanma F. Pos-074 Serum Neutrophil Gelatinase Associated Lipocalin, Early Biomarker Of Acute Kidney Injury In Asphyxiated Term Neonates At Lagos State University Teaching Hospital. Kidney International Reports. 2022;7(2):S31.

ORIGINAL: Evaluating the Factors Influencing Bacterial Vaginosis in Pregnant Women: An Analytical Cross-Sectional Study

O. M. Oyedeko — 2024-08-30

Introduction: Bacterial Vaginosis (BV) has consistently been associated with adverse obstetric and gynaecological outcomes. It is a common vaginal condition. This study determined the prevalence and factors associated with BV among pregnant women.

Methods: This study was a prospective analytical cross-sectional study in which 350 pregnant women, attending the antenatal clinic of the Lagos State University Teaching Hospital, over 6 months, had high vaginal swab samples taken aseptically and examined for Bacterial Vaginosis using the Nugent scoring system. Relevant sociodemographic, obstetric and gynaecologic data were obtained with a structured interview-based questionnaire. The odds ratio (OR) and 95% confidence intervals (CI) for possible risk factors for BV were determined.

Results: The prevalence of bacterial vaginosis in pregnancy was 32%. Bacterial vaginosis was independently associated with no formal education [OR 4.19, 95% CI 2.47-4.56, p= 0.001]; primary education (OR 3.50, 95% CI 2.42-4.14, p<0.001); secondary education (OR 1.75, 95% CI 1.16- 2.41, p=0.009); increased coital frequency (OR 1.78, 95% CI 1.24-2.31, p=0.003); douching with water (OR 2.69, 95% CI 1.41- 4.43; p=0.004); douching with Dettol (OR 7.19, 95% CI 2.51- 8.61, p=0.004); douching with soap (OR 5.76, 95% CI 3.54-7.41, p< 0.001); HIV infection (OR 2.75, 95% CI 1.65-3.15, p=0.003) and obesity (OR 1.77 95% CI 1.20- 2.33, p=0.006).

Conclusion: The prevalence of bacterial vaginosis is high in pregnancy. It is significantly associated with low levels of education, increased coital frequency, douching, HIV infection, and obesity in pregnancy.

ORIGINAL: Prevalence of Acute Kidney Injury (AKI) in Children with Severe Malaria Using a Novel Biomarker: Serum Neutrophil Gelatinase Associated Lipocalin (NGAL) in Enugu

H. U. Okafor — 2024-08-30

Objectives: This study aims to determine the prevalence of Acute Kidney Injury (AKI) among children with severe malaria who present to the emergency room, using serum creatinine and NGAL levels as biomarkers. It also aims to ascertain which biomarker (serum creatinine and NGAL) detects AKI earliest, especially at day 0. The study is also aims to determine the relationship between parasite density and levels of serum NGAL.

Methods: This was a cross-sectional and observational study carried out in the Children's emergency room (CHER) of two tertiary institutions which also served as referral centres for children with renal disease in Enugu metropolis.

Results: The prevalence of AKI using NGAL at day 0 was 74.4% while with NGAL at day 2, it was 35.9%. The prevalence of AKI using serum creatinine at day 0 was 7.7% while with that at day 2 was 5.1%. There was a very weak negative correlation between parasite density count and serum creatinine at 48 hours but this was not found to be statistically significant, (n=38, r=-0.156, p=0.499). There was a moderate positive correlation between creatinine at 0 hours and NGAL at day 2, r = 0.483; p = 0.017). There was also a moderate positive correlation between creatinine at 48 hours and NGAL at day 2, (r (21) = 0.565; p = 0.005). A significant regression equation was found F (1, 21) = 5.844, p < 0.025 with an adjusted R2 of 0.180. Participants predicted serum creatinine at day 2 was equal to - 1.96 + 0.179 x (serum NGAL at day 48). Serum creatinine at day 2 increased by 0.179 for every unit increase in NGAL.

Conclusion: This study has documented a high prevalence of AKI using NGAL. It also showed the importance of NGAL in predicting AKI earlier than creatinine at day zero and 48 hours.

ORIGINAL: Effectiveness of Monthly Versus Two-Dose Regimen of Sulphadoxine-Pyrimethamine for Intermittent Preventive Treatment of Malaria in Pregnancy in Southeastern Nigeria: A Randomised Controlled Trial

G. U. Odoh — 2024-08-30

Background: There are reports of a high prevalence of maternal peripheral and placental malarial parasitaemia (MP) in southeastern Nigeria following the two-dose regimen of sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment (IPT) of malaria in pregnancy.

Objective: To compare the effectiveness of monthly versus two-dose regimens of SP for IPT of malaria in pregnancy in Enugu, south-eastern Nigeria.

Methods: A randomized controlled trial involving antenatal clinic attendees at the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Nigeria. Pregnant women at gestational ages between 13 - 24 weeks were randomized into two groups; intervention group and control group to receive monthly dosing and a two-dose regimen of IPT-SP respectively. Peripheral and placental malaria parasitaemia (MP) and other outcome measures were compared between the two groups.

Results: Prevalence of placental parasitaemia ( 18% vs. 40.6%; RR: 0.44; 95% CI: 0.27 - 0.72; P < 0.001) and maternal peripheral parasitaemia (10.0% vs. 31.7%; RR: 0.32; 95% CI: 0.16 - 0.61; P < 0.001) were significantly lower in the intervention compared to the control group. Similarly, maternal anaemia (39.0% versus 57.4%, p<0.05), neonatal malaria parasitaemia (5.0% versus 16.8%, p < 0.05) and neonatal anaemia (10.0% versus 23.8%, < 0.05) were all significantly lower in the intervention than the control group. However, the incidence of low birth weight (LBW) did not differ between the two groups (P=1.0).

Conclusion: Monthly IPT-SP is more effective in preventing malaria in pregnancy than the standard two-dose regimen. We recommend the universal adoption of this regimen in all obstetric care units.

ORIGINAL: The Impact of Diabetes Self-Management Education (DSME) on the Quality of Life of patients living with type-2 Diabetes Mellitus in Nigeria

A. Osonuga — 2024-08-30

Background: Type 2 diabetes mellitus (T2DM) significantly affects the quality of life (QoL), necessitating comprehensive management strategies. In resource-limited settings such as Nigeria, managing diabetes can be challenging due to limited access to medications, which impacts patients' QoL. Diabetes Self-Management Education (DSME) empowers patients through knowledge and skills, potentially improving their QoL. This study aimed to assess the impact of DSME on the QoL of T2DM patients in Nigeria.

Methodology: A quasi-experimental (pre-test and post-test) design was employed at the Olabisi Onabanjo University Teaching Hospital in Nigeria. Adult patients with uncomplicated T2DM who regularly attended the diabetic clinic were systematically sampled. Data was collected using a structured questionnaire covering demographics, QoL, self-monitoring knowledge, and self-management competence. A DSME program, including modules on nutrition, exercise, and foot care, was implemented. Pre- and post-intervention measurements were taken, and the data was analyzed.

Results: The study revealed significant improvements in all QoL domains after the DSME intervention, including physical functioning, role-physical, bodily pain, general health, social functioning, role-emotional, and mental health (p<0.001 for most domains). Postintervention, self-management competence scores showed a significant increase (mean difference: -9.655, p<0.001), and fasting blood glucose levels decreased significantly following DSME (mean difference: 14.897 mg/dL, p<0.001). Multivariate regression analysis demonstrated that DSME significantly enhanced post-intervention QoL scores (coefficient: 3.5054, p=0.001). Higher baseline QoL and education levels were positively associated with better outcomes.

Conclusion: The findings highlight that DSME significantly enhances the QoL, self-management competence, and glycemic control among T2DM patients in Nigeria. These results underscore the importance of structured educational interventions in diabetes care, particularly in resource-limited settings.

ORIGINAL: The Pre-Fibroscan and Fibroscan Era: A Comparative Study of Histologic Diagnosis of Liver Biopsies

I. Emmanuel — 2024-08-30

Background: The advancement in non-invasive methods for diagnosing and characterizing liver disease has achieved significant success. One such methods, FibroScan, combines non-invasiveness, rapidity, painlessness, and reproducibility. However, its accuracy and value are limited in many clinical settings. The liver biopsy, the gold standard for assessing liver fibrosis offers direct visualization and provides extensive information through histology and ancillary investigations a noticeable gap of Fibroscan and other non-invasive methods.

Aim and objective: To determine the rate of histology requests by gastroenterologists and surgeons at the Jos University Teaching Hospital during the pre-FibroScan era and the FibroScan era in the Jos metropolis.

Methodology: Patient biodemographic information and histologic diagnoses, along with the category of the requesting physician (gastroenterologist or surgeon) for liver biopsies, were extracted from hospital records. Data were collated for the pre-FibroScan era (2004-2010) and the FibroScan era (2011-2023), spanning 20 years. All patients with liver biopsies submitted for histologic analyses were included while those with inadequate biodemographic data, histologic diagnoses, and category of requesting physician were excluded.

Results: Two hundred and eighteen (218) liver biopsies were received during the study of the period. Of these, two hundred and eight (95.4%) met the study criteria, with 111 (53.4%) from the pre-FibroScan era and 97 (46.6%) from the FibroScan era. In the pre-Fibroscan era,110(99.09%) 1(0.01%) histology requested were by gastroenterologist and surgeons respectively, while in the Fibroscan era the respective requests by these specialties were 36(37.11%) and 97(62.89%). The first year of the Fibroscan era (2011) accounted for 22(61.11%) of the 36(100.00%) cases liver biopsies requested by gastroenterologist, with a corresponding value of 11(16.67%) of 66(100.00%) for surgeons. The significance concerning the requesting physician's specialty with p-value of 0.003.

Conclusion: For the foreseeable future, the FibroScan cannot replace the value of direct tissue histological assessment, especially where molecular studies and other ancillary investigations are crucial for targeted therapy and research. Histology remains the gold standard for the aforementioned reasons and probably will until the non-invasive investigations can provide the myriads of valuable information it avails.

ORIGINAL: Assessment of School Counsellors' Knowledge and Attitude Towards Mental Illness and Suicide: A Pre-Intervention Survey

O. I. N. Buhari — 2024-08-30

Background and objectives: School counsellors, who should be able to help students with mental health problems, often struggle to identify and refer individuals with mental health challenges due to poor mental health literacy. This study aimed to evaluate school counsellors' knowledge and attitudes towards mental illness and suicide.

Methods: This was a pre-intervention mixed-method survey conducted among University of Ilorin counsellors using questionnaire and key-informant interviews to assess sociodemographic variables, prior mental health training, knowledge of mental health problems, and attitudes towards mental illness and suicide. Data was analyzed using IBM Statistical Product and Service Solution (SPSS) version 26.0 and thematic analysis.

Results: The mean age of respondents was 49 ± 7.26 years. The majority (70%) were female, 60% of whom had master's degree. All 10 respondents had encountered students with mental health symptoms. Majority (80%) referred students with mental health symptoms to the school clinic. Identified risk factors for mental illness among students were interpersonal relationships, financial problems, medical problems, and academic stress. Only one respondent felt confident in assessing suicide risk and knew of local resources that could be used. All respondents identified the need for regular training to improve their skills.

Conclusions: Findings showed markedly poor awareness of symptoms of suicidal behaviour, including poor knowledge of first aid skills to help students with suicidality. It is hoped that these findings will help in developing mental health training programs for university counsellors.

ORIGINAL: Pattern of Rheumatic Diseases in a New Rheumatology Clinic in Southwestern Nigeria: A Descriptive Study

G. J. Odunlami — 2024-08-30

Background/objective: Rheumatic diseases (RMDs) are among the leading health burdens and causes of disability globally. Interestingly, they are on the rise due to the increasingly ageing population. Inflammatory RMDs are not left behind in the rise, especially in Africa, where they were thought to be rare as there has been increasing reportage of these diseases in recent years. Hence, this study aims to determine the pattern of RMDs presenting to a rheumatology clinic in southwestern Nigeria.

Methods: In this retrospective study, the medical records of the patients who were diagnosed with RMDs who presented to the rheumatology clinic of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) between February 2017 and April 2024 were reviewed and the data about their age, sex, and diagnoses were collated between May and June 2024. The diagnosis of RMDs was made based on various classification criteria and critical clinical evaluation by a rheumatologist. Non-rheumatic diseases were excluded from the study. The data were analysed using the IBM SPSS version 23.0 software to determine the characteristics of the various RMDs.

Results: About 416 patients were seen during the study period. Three hundred and eighteen were females, while 98 were males with a F: M ratio of 3.2:1. The mean age of the patients was 48.62 years. Inflammatory RMDs were the most common (59.4%). Systemic lupus erythematosus was the most common RMD (21.2%) followed by osteoarthritis (19.7%). Rheumatoid arthritis was the most common inflammatory arthritis (11.8%). Trigger finger was the most common soft tissue RMD (4.8%) followed by rotator cuff tendinitis (3.6%).

Conclusion: This study showed an evolving trend toward inflammatory RMDs contrary to earlier African studies.

ORIGINAL: Prevalence, Pattern and Factors Associated with Consumption of Sweetened Beverages Among Adolescents in Ogun State, Nigeria

A. A. Gbadebo — 2024-08-30

Background: Globally, there has been an increase in the trend of sugar-sweetened beverages (SSB) consumption among adolescents and this has been implicated in the increased prevalence of diet-related NonCommunicable Diseases.

Objectives: This study compared the pattern of sweetened beverage consumption and factors associated with consumption among adolescents in rural and urban areas of Ogun State, Nigeria.

Methods: A comparative cross-sectional study was conducted among in-school adolescents in rural and urban areas of Ogun State. Respondents were selected via a multistage sampling method using a semi-structured questionnaire. Sugar-sweetened Beverage consumption was based on the estimated volume and frequency of SSB consumed daily. The quantity of SSB consumed in the previous day was summed up to the nearest ml to create three categories of SSB consumption: low - less than 350mls/day; moderate - 350-700mls/day; and high - more than 700mls/day. Data were analysed with the aid of SPSS 23.0. Descriptive and inferential statistics were calculated, and the significance level was set at a 95% confidence interval with a P value≤0.05.

Results: A total of 1796 adolescents participated in this study. The lifetime prevalence of SSB consumption was higher in rural (96%) than in urban areas (85.9%). The difference was statistically significant with the location of respondents (χ2=55.875; p =0.001). The current prevalence of SSB consumption was higher in rural (77.6%) than in urban areas (74.6%), however this was not found to be statistically significant (χ2=2.061; p =0.151). Age (AOR=0.47, 95%CI=0.23-0.99) and mother's education (AOR=8.80, 95%CI=1.35-57.41) were predictors of SSB consumption among adolescents in the rural area, while ethnicity was the only predictor of SSB consumption among adolescents in the urban area (AOR=0.12, 95%CI=0.02-0.95).

Conclusion: The prevalence of SSB consumption was high among adolescents in the rural and urban groups. While carbonated drinks were the most consumed SSB across both groups, caffeinated drinks were the least consumed. Age, mother's education and ethnicity were predictors of SSB consumption among adolescents in this study. Efforts should be made to institute strategies that influence adolescents to make healthier food choices.