Open Access Original Research Article

Assessment of Accuracy and Effectiveness of Rapid Diagnostic Test for Malaria Diagnosis at Primary Health Centres in Abeokuta Nigeria

A. Idowu Olufunmilayo, M. Odeyemi Oluwatosin, S. Babalola Ayodele

International Journal of TROPICAL DISEASE & Health, Page 90-97
DOI: 10.9734/IJTDH/2015/17725

Malaria is a deadly disease that needs proper and prompt diagnosis in order to treat its symptoms as early as possible. Rapid diagnosis test is a pre-requisite for the effective treatment of malaria in other to reduce the mortality and morbidity of the disease especially at the Primary Health Centre (PHC) facilities. This study compares RDTs test results from PHCs with malaria Quantitative Buffy Coat (QBC) and microscopy test results. A total of 113 subjects with clinical signs of malaria were enrolled after obtaining consent of patients at the Primary Health Centres and questionnaires administered to assess awareness and use of RDTs kit. Storage and compliance to standards of usage of the Kits were observed. The results were analyzed using SPSS version 16.0. There was a significant difference (p<0.05) in sensitivity to malaria parasite between the three diagnostic methods as QBC was more sensitive compared with other diagnostic methods, while Microscopy was more sensitive compared with RDT kits. A total number of 86(76.1%), 28(24.8%) and 39(34.5%) malaria positive cases were detected by QBC, RDT and Microscopy respectively. Out of the 86(76.1%) blood samples confirmed positive by QBC, 27(31.4%) and 38(44.2%) positive cases were detectable by RDT and Microscopy respectively. Furthermore, Microcopy detected 15(53.6%) of the total positive cases detected by RDT, while RDT was able to detect 15(34.5%) of the total positive cases detected by microscopy. When compared with QBC, RDT shown a sensitivity and specificity of 32.56% (95% Cl= 22.84 – 43.52%) and 31.76% (95% Cl= 22.09% - 42.76%) respectively. On the other hand, 71.8% (95% Cl=55.12% - 84.98%) sensitivity and 87.1% (95% Cl= 78.02 – 93.35%) specificity was shown by RDT when microscopy was used as gold standard. Compliance to manufacturer’s instruction on RDT usage was poor as some of the health workers collected the blood sample directly from the pricked finger into the sample well rather than the designated capillary pipette method, while others did not comply with time before reading the results of the kits. The result from this study showed that the sensitivity and accuracy of RDTs kit is low and there is need for proper training of the health workers to avoid misuse of the kit.

Open Access Original Research Article

Socio-Demographic Profile and Symptom Presentation of Young People Diagnosed with Essential Hypertension in Uyo, South-South Nigeria

Umoh Kufre Albert, Okeke Daniel Ogbonna

International Journal of TROPICAL DISEASE & Health, Page 98-103
DOI: 10.9734/IJTDH/2015/17474

Hypertension is a chronic medical condition where the systemic arterial blood pressure is elevated. It is taken as blood pressure reading greater than or equals to 140/90 mmHg systolic and greater than or equals to 90 mmHg diastolic. Recently, there is an upsurge in the diagnosis of essential hypertension among young people attending the general outpatient clinic so this generated the interest to study the socio-demographic variables and symptom presentation of these young people diagnosed with hypertension.
Aim: To determine the socio-demographic features of young people diagnosed with essential hypertension and the common clinical features.
Methods: A cross-sectional descriptive study of young people aged 20-44 years diagnosed with essential hypertension over a one year period January –December 2013 at General outpatient department of University of Uyo teaching hospital were recruited into the study. The questionnaire sought information on socio-demographic characteristics and symptoms presented by the respondents. Blood pressure was measured and classified into stage 1 and stage 2 hypertension according to JNC 7.
Results: One hundred and fifty one respondents with essential hypertension were recruited into the study. 62.8% of them had stage 2 hypertension, most of them were in age group 35-39 years n=44 (29.1%), were females n=84 (55.6%). More than half of respondents had tertiary education n=70 (46.4%), traders were more than others in terms of occupation n=46 (30.5%). Common symptoms presented were headache n=106 (70.2%), dizziness n=77 (51.0%) insomnia n=76 (50.3%), palpitation n=88 (58.3%). Insomnia and palpitation were significantly associated with stage 2 hypertension with p value of 0.031 and 0.013 respectively.
Conclusion: Hypertension is becoming common among young people in our facility; insomnia and palpitation are associated with stage 2 hypertension among these young people, so there is need to screen young people that present with these symptoms for high blood pressure.

Open Access Original Research Article

Influence of Rheumatoid Factors and Bilirubin on the Sensitivity of Immunochromatographic Rapid Diagnostic Tests for HIV/AIDS and Hepatitis B in Cameroon

Séverin Donald Kamdem, Palmer Masumbe Netongo, Michel Kengne, Jacqueline Dongtsa, Takam Patricee, Donfack Sontsa Olivier Trésor, Barbara Atogho-Tiedeu

International Journal of TROPICAL DISEASE & Health, Page 104-112
DOI: 10.9734/IJTDH/2015/16624

Aim: We aimed at studying the influence of some potential interference factors on the immunochromatographic Rapid Diagnostic Tests commonly used in Cameroon for the diagnosis of Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome (HIV/AIDS) and Hepatitis B (HBV) which are major public health problems in the country.
Design and Methods: The sample population of this cross-sectional study included patients referred to the BETHANIE Laboratory for the accurate diagnosis of HIV/AIDS and HBV. RDTs were performed using FIRST RESPONSE HIV Card 1-2.0 and HEXAGON HBsAg. Tests results were confirmed using a high sensitivity 3rd generation ELISA for HIV and HBV, both from FORTRESS. Assays of Rheumatoid Factors and bilirubin were conducted on HIV and HBV samples respectively. Statistical analysis was done using the R software version 3.0.2; the Chi-square test with continuity correction was applied at a threshold of 0.05.
Results: A total of 25 patients were included for the HIV study group and 30 for the HBV group. Test sensitivities of 14.28% and 92.85% for FIRST RESPONSE HIV Card 1-2.0 and HEXAGON HBsAg were found respectively. Average blood levels of RF were 11.55 IU / L and 64.29 IU / L from FIRST RESPONSE HIV RDT positive and negative samples respectively. Blood levels of bilirubin were 88.63 mg / L and 131.66 mg / L from HEXAGON HBsAg RDT positive and negative samples respectively.
Conclusion: HIV FIRST RESPONSE RDT results were independent (P-value = 1.00) of Rheumatoid Factor values (up to 238.8 IU / L). However, we found that HEXAGON HBsAg RDT results were not independent of bilirubin values (P-value = 0.01547), suggesting that the latter could potentially have an influence on the former.

Open Access Original Research Article

A Cross-sectional Study of Adherence to Lifestyle Modifications among Ambulatory Type 2 Diabetic Nigerians in a Resource-poor Setting of a Primary Care Clinic in Eastern Nigeria

Gabriel Uche Pascal Iloh, Godwin Oguejiofor Chukwuebuka Okafor, Agwu Nkwa Amadi, Chikere Ifeanyi Casmir Ebirim

International Journal of TROPICAL DISEASE & Health, Page 113-123
DOI: 10.9734/IJTDH/2015/16069

Background: Despite the evidence that lifestyle modifications (LSMs) play important role in glycaemic control, adherence to healthy lifestyles has been variable in Nigeria and this has great impact on the success or failure of pharmacological care.
Aim: The study was designed to determine adherence to LSMs among ambulatory type 2 diabetic Nigerians in a resource-poor setting of a primary care clinic in Eastern Nigeria.
Study Design: This was a primary care clinic-based cross-sectional study done on consecutively sampled 120 adult type 2 diabetic patients who were on management for diabetes mellitus for at least 3 months at the primary care clinic of a tertiary hospital in Nigeria.
Place and Duration of Study: The study was carried out at the primary care clinic of a tertiary hospital in South-Eastern Nigeria from April 2011 to December 2011.
Methodology: Instrument of data collection was pretested, structured and interviewer-administered questionnaire. Each item of lifestyle was scored on a five points Likert scale ordinal responses of always, most times, sometimes, rarely and none. Adherence to lifestyle modifications was assessed in the previous 12 months for alcohol and tobacco use and 7 days for physical activity, dietary fruits, vegetables, fats and oil consumptions. Each of the domains of lifestyle was given a score of one point for healthy lifestyle and zero point for unhealthy lifestyle. Type 2 diabetic patients who scored 6 points in all the evaluated domains were adherent. Awareness of LSMs and Specific adherence to lifestyle factors were also determined.
Results: The awareness and overall adherence rates to LSMs were 88.3% and 22.5% respectively Specifically, adherence was highest with the non-tobacco use (100.0%) followed by adequate dietary vegetables consumptions (96.7%) and non-use of alcohol (90.8%). Other adherence rates were consumptions of adequate dietary fruits (51.7%), dietary fat and oils (23.3%) and physical activity (22.5%). Adherence was significantly associated with young age <40 years (p=0.039).
Conclusion: The awareness of LSMs was high but was not translated to comparative adherence. The adherence to non-tobacco use was rated highest and physical activity the lowest. Young age <40 years was significantly associated with adherence. Targeting the domains of inadequate adherence for improvement is a primary care imperative especially in resource-poor settings where there are limited options for healthy living.

Open Access Original Research Article

A Review of Maternal Deaths at Douala General Hospital, Cameroon: The Referral System and Other Contributing Factors

Gregory Edie Halle Ekane, Fulbert George Nkwele Mangala, Thomas Egbe Obinchemti, Charlotte Tchuente Nguefack, Theophile Nana Njamen, Jacques Tsingaing Kamgaing, Eugene Belley Priso

International Journal of TROPICAL DISEASE & Health, Page 124-133
DOI: 10.9734/IJTDH/2015/18111

One of the objectives of the fifth Millennium Development Goal [MGD] is to decrease annually by 5.5% the maternal mortality so as to attain a three- quarter’s reduction of the world’s burden by the year 2015. The health care referral system has been shown to play an important role if this objective is to be attained. The aim of this study was to evaluate the referral system and other contributing factors to maternal deaths. This was a retrospective, descriptive study carried out in the Douala General Hospital, a tertiary referral hospital in Douala, Cameroon. The records of cases of maternal deaths that occurred between 1st January, 2002 and 31st December, 2011 were reviewed. Patients who died on arrival at the hospital were excluded from the study. Data was collected using pre-structured questionnaire and analyzed with EPI-Info version 3.5.1. There were 25 maternal deaths during this period with a maternal mortality ratio of 275 per 100.000 live births. Sixteen (64%) maternal deaths were referred cases from; government health institutions 4 (25%) and private 12 (75%) hospitals in Douala. Most of the patients were between 30-40 years 12 (48%), married 17 (68%), primigravida 12 (48%). The triad of hemorrhage 12 (48%), hypertensive disease in pregnancy 10 (40%) and infection 3 (12%) was responsible for the maternal deaths. Using two indicators to evaluate the referral system, it was observed that only 3 (18, 8%) exploited the referral information system and barely 4(25 %) were transported to the hospital by an ambulance. Maternal mortality remains high in our setting. Most of the causes of maternal death are due to direct obstetric causes which are preventable. The role of referral system in providing health care is poor. Therefore, this aspect of providing health care has to be properly implemented if it is to make an impact in reducing maternal morbidity and mortality.