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There has been a rise in burden and risk factors for development and progression of diabetes mellitus in developing countries. The associated multisystemic complications and the burden of care potentially impair mental health status of sufferers. This study was aimed at assessing mental health status among diabetic patients in a developing country setting. Case-control study design was used, and subjects were recruited using random sampling method. Cases were recruited from medical wards and clinics in the University of Calabar Teaching Hospital, Calabar, for 14 weeks beginning mid-April through mid-July 2019. Age- and sex-matched non-diabetic normotensive controls were civil servants. Validated and pretested PHQ-9 instrument was used to assess mental health status, and clinical depression was defined as score > 10. p value was set at 0.05. One hundred and sixty-five diabetic patients and their matched controls were studied, with male/female ratio of 1:0.9. Mean age was 54.9 ± 9.6 years. Prevalence of clinical depression was 17.2% and 23.1% for male and female diabetics, respectively. For both male and female subjects, significantly higher proportion of cases compared with controls had clinical depression (p

Henry Ohem Okpa,1,2 Elvis Mbu Bisong,3 Ofem Egbe Enang,2,4 Emmanuel Edet Effa,1,2 Emmanuel Monjok,3,5 Ekere James Essien51Renal Unit, Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria; 2Department of Internal Medicine, University of Calabar, Calabar, Nigeria; 3Department of Family Medicine, University of Calabar, Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria; 4Endocrine and Metabolism Unit, University of Calabar Teaching Hospital, Calabar, Nigeria; 5Institute of Community Health, University of Houston, Texas Medical Center, Houston, TX, USABackground: The burden of the people living with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS) is largely borne by communities in Sub-Saharan Africa. The rate of kidney disease is increasing amongst HIV patients and occurs more often in patients with advanced stage of the disease with lower CD4 counts and associated with a high rate of morbidity and mortality. The objective of this study is to determine the prevalence and predictors of chronic kidney disease (CKD) amongst HIV patients on highly active antiretroviral therapy (HAART) at the University of Calabar Teaching Hospital, Calabar.Materials and methods: This was a cross-sectional study that was carried out over a 4-month period from May to August 2018. In all, a total of 118 patients with HIV on HAART were recruited into the study in a consecutive manner and their serum creatinine measured with the calculation of estimated glomerular filtration rate (eGFR). Other data collected were sex, age, weight, height, body mass index (BMI), waist hip ratio (WHR), packed cell volume, CD4 count etcetera. Data collected were inputted and analyzed with SPSS version 18, and statistical significance was taken to be p

The International Diabetes Federation estimates that 1.6 million (1 in 53) Nigerian adults have diabetes mellitus while 60.7% (949,900) of Nigerian adults with diabetes are undiagnosed. In spite of these worrying projections, current nationwide data on diabetes prevalence to aid policy formulation in Nigeria is non-existent. This was a cross-sectional observational study that recruited 1200 adults residing in the Southern Cross River State. Glucometers were used to measure the fasting capillary glucose of participants, and those with readings ≥ 7 mmol/l were asked to come back the following day for another fasting blood glucose check for confirmation. Those who had two fasting blood glucose readings consistently ≥ 7 mmol/l were classed as having diabetes mellitus and referred to the nearest hospital for further evaluation and management. Blood pressure and waist circumference were also measured. There were 683 (56.9%) females and the mean age of the participants was 41.3 ± 15.3. Using body mass index (BMI), 159 (13.3%) participants were found to be obese. The prevalence of diabetes mellitus among the tested participants was 6.9%. Univariate analysis was carried out to identify associations with diabetes among the participants. Statistically significant associations were identified between blood pressure > 140/90 mmHg (p = 0.013), local government area (p = 0.001), level of education (p = 0.002), and diabetes. The diabetes mellitus prevalence of 6.9% in this community is much higher than internationally reported estimates for Nigeria and makes a compelling case for further epidemiological studies on diabetes in Nigeria and prioritisation of this disease by health policy makers.

Introduction:among hypertensive patients, the comorbidity of diabetes is not uncommon. Yet, little is known about diabetes prevention among non-diabetic hypertensive patients. This study sought to assess such patients' knowledge about diabetes and its risk factors. Methods:a cross-sectional descriptive study design and random sampling were used to recruit non-diabetic hypertensive patients from University of Calabar Teaching Hospital. A pretested 33-item questionnaire was used to assess various aspects of diabetes knowledge. Participants' alcohol consumption, smoking habits, physical activity, and fresh fruit consumption were also assessed. The p-value was set to 0.05. Results:of 212 respondents with a mean age of 45.5 ± 10.8 years, approximately half (49.1%) had inadequate knowledge of diabetes. Most participants demonstrated poor knowledge of diabetes' clinical features (81.1%) and complications (59.4%), while fewer participants showed poor knowledge of causes and risk factors (24.5%) and diabetes management (40.6%). Older subjects, those in the wards, non-drinkers, physically active people, and those who frequently consumed fresh fruit had a significantly greater understanding of diabetes symptoms and complications (p

Henry Ohem Okpa,1 Elvis Mbu Bisong,2 Ofem Egbe Enang,1 Emmanuel Monjok,2,3 Ekere James Essien3 1Department of Internal Medicine, 2Department of Family Medicine, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria; 3Institute of Community Health, University of Houston, Texas Medical Center, Houston, TX, USA Background: The introduction of highly active antiretroviral therapy (HAART) has remarkably improved the prognosis of human immunodeficiency virus (HIV)-infected patients, at the expense of the development of long-term complications such as cardiovascular and renal diseases. Hypertension (HTN) is a major risk factor for cardiovascular diseases and its associated mortality. In this study, we aimed to determine the prevalence of HTN and to identify possible predictors among HIV-infected patients attending the HIV Special Treatment Clinic at the University of Calabar Teaching Hospital, Calabar.Materials and methods: A cross-sectional study was carried out over a 5-month period from February to July 2016. A total of 112 HIV-infected persons were consecutively recruited and their blood pressures were measured in two consecutive clinic visits. They were compared with the HIV-negative control group (n=309). Data collected were analyzed with SPSS 18, and statistical significance was set at P40 years), increased weight and body mass index (BMI), and presence of obesity. Male sex and duration of exposure to HAART and CD4 count levels >200 cells/mm3 were associated with HTN in HIV-infected patients, whereas the absence of family history of HTN was significantly associated with HTN in both groups. However, in a multivariate logistic regression, the predictors of HTN in both groups are absence of family history of HTN and older age in HIV-infected patients and HIV-negative subjects, respectively.Conclusion: Traditional risk factors such as older age, increased BMI, and obesity were linked to HTN in both HIV-infected and HIV-negative subjects, but higher CD4 count level and cumulative HAART exposure were associated with HTN in HIV-positive individuals. In a multivariate logistic regression, the predictors of HTN in both groups are absence of family history of HTN and older age in HIV-infected patients and HIV-negative subjects, respectively. Keywords: hypertension, urban, HIV, population, Calabar, Nigeria

Key Clinical Message While chronic pulmonary aspergillosis (CPA), pulmonary tuberculosis (PTB), and Klebsiella pneumoniae pneumonia co‐infection is rare, we present a 50‐year‐old woman with uncontrolled diabetes who presented with these three diseases. There is considerable overlap in symptoms of PTB and CPA. Treatment with antifungals, anti‐tuberculosis therapy, and antibiotics is beneficial.

BACKGROUND: Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk. METHODS: We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cut-points for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC. RESULTS: The optimal WC cut-point was 81.2 cm (95% CI 78.5-83.8 cm) and 81.0 cm (95% CI 79.2-82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63-65) than in men (53%, 95% CI 51-55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4-2.9, for men and 2.2, 95% CI 2.0-2.3, for women). CONCLUSION: The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes.International Journal of Obesity advance online publication, 31 October 2017; doi:10.1038/ijo.2017.240.

Background Diabetes is now a global epidemic, but most cases are now in low- and middle-income countries. Diabetes self-management education (DSME) is key to enabling patients to manage their chronic condition and can reduce the occurrence of costly and devastating complications. However, there is limited evidence on the effectiveness of different DSME programmes in resource limited settings. Methods We conducted an unblinded, parallel-group, individually-randomised controlled trial at the University of Calabar Teaching Hospital (Nigeria) to evaluate whether an intensive and systematic DSME programme, using structured guidelines, improved glycaemic control compared to the existing ad hoc patient education (clinical practice was unchanged). Eligible patients (≥18 years, HbA1c > 8.5% and physically able to participate) were randomly allocated by permuted block randomisation to participate for six months in either an intensive or conventional education group. The primary outcome was HbA1c (%) at six-months. Results We randomised 59 participants to each group and obtained six-month HbA1c outcomes from 53 and 51 participants in the intensive and conventional education groups, respectively. Intensive group participants had a mean six-month HbA1c (%) of 8.4 (95% CI: 8 to 8.9), while participants in the conventional education group had a mean six-month HbA1c (%) of 10.2 (95% CI: 9.8 to 10.7). The difference was statistically (P < 0.0001) and clinically significant, with intensive group participants having HbA1c outcomes on average -1.8 (95% CI: -2.4 to -1.2) percentage points lower than conventional group participants. Results were robust to adjustment for a range of covariates and multiple imputation of missing outcome data. Conclusions This study demonstrates the effectiveness of a structured, guideline-based DSME intervention in a LMIC setting versus a pragmatic comparator. The intervention is potentially replicable at other levels of the Nigerian healthcare system and in other LMICs, where nurses/diabetes educators can run the programme. Trial Registration Pan African Clinical Trial Registry PACTR20130200047835