Open Access Review Article

Medical Tourism, Public Health and Economic Development in Nigeria: Issues and Prospects

U. U. Epundu, E. D. Adinma, B. O. Ogbonna, O. C. Epundu

Asian Journal of Medicine and Health, Page 1-10
DOI: 10.9734/AJMAH/2017/36658

Background: Nigeria is a densely populated nation with a high prevalence of communicable diseases and increasing prevalence of non-communicable diseases, a manifestation of the “double burden of disease” concept. This is partly due to poor healthcare delivery system. Nigerians have joined the ever-increasing number of people who travel abroad for the treatment of various medical conditions.

Objective: To discuss the concept, effects, and consequences of medical tourism on the Nigerian healthcare delivery system and economy

Methods: The study was a narrative overview of selected studies published in the English Language in Google scholar, Pubmed, Medline, and recognized reference materials. Search terms were medical tourism, health tourism, public health, health system, Nigeria, and health access. The terms were individually used and in a combination of two or more using AND/OR as link words with truncations where necessary. The study period covered January2006 to August 2017, and lasted from January 2016 to July 2016.

Results: Nigeria with an estimated population of 180 million people loses $1.35 USD Billion annually to medical tourism. An average of 9000 medical tours occurs monthly from Nigeria to other countries. India is a major destination with an average of 500 visits monthly and affordable treatments in modern medicine and specialties. The average growth rate of medical tourism in Nigeria is 20.0% annually. In 2013, 34,522 Nigerian tourists visited India, out of which 15328 (42.4%) were medical tourists. An estimated 700 Nigerian doctors move to Europe annually. 

Conclusion: Poor healthcare delivery system encourages migration of medical tourists from Nigeria. This leads to loss of huge foreign exchange and medical work force. This coupled with poor government expenditures on healthcare has impoverished the sector. Improved and sustained health sector spending by the government with good public sector support in healthcare are major leveraging mechanisms.

Open Access Original Research Article

Influence of Vitamin D Level on Diabetic Dyslipidemia

Mohamed Mashahit, Alaa Elsayed, Hala Eltoukhy

Asian Journal of Medicine and Health, Page 1-11
DOI: 10.9734/AJMAH/2017/36086

Background: Vitamin D deficiency is greater than expected all over the world and it is linked to many health and disease conditions.

Aim of the Work: Our work aimed to study the relation between serum level of vitamin D 25( OH ) and lipid parameters.

Patients and Methods: This study included 176 participants 88 patients with type 2 diabetes mellitus and 88 clinically healthy volunteers age and sex matched persons with normal glycated hemoglobin as a control group and their age ranged from 30 to 60 years old. A full history and clinical examination were done for both patients and control group. Fasting samples (12hrs) for lipid parameters including total cholesterol, triglycerides, (HDL) and (LDH), serum 25 (OH) vitamin D level ,fasting blood sugar and 2 hour postprandial and (HbA1c).

Results: In this study 71 patients had vitamin D deficiency (80.7%) and 17(19.3%) patients had either vitamin D insufficiency or sufficiency. Compared to the control group which showed that 38 persons had deficient vitamin D (43.2%) and 50 (56.8%) had either vitamin D insufficiency or sufficiency, which demonstrate that there were high statistical significance difference between case and controls regarding to 25(OH)D with p-value <0.001. Although in diabetic patients with vitamin D deficiency, serum levels of total cholesterol, TG, and LDL were higher and HDL was lower compared to patients with vitamin D sufficiency, this association was statistically significant for serum level of TG (237.3 ± 120.9 vs. 186.3 ± 77.0), and HDL (33.5 ± 6.4 vs. 40.4 ± 13.2), with P=0.037 and 0.003, respectively. Also in the control group there was a statistically significant difference between participants with vitamin D deficiency when compared to those without regarding the mean values of triglycerides (257.4 ± 106.2 vs. 155.8 ± 108.9), and HDL (30.7 ± 10.1 vs. 44.3 ± 15.5), with P<0.0001. This study also revealed that there was a negative statistically significant correlation between vitamin D level and HbA1C (P=0.035) in diabetic group.

Conclusions: The results of the present study showed that serum concentrations of 25(OH) D were inversely associated with high TG and low HDL in both diabetics and control groups.

Open Access Original Research Article

Breast Cancer Screening Trend Year 2017 among South-Western Nigeria Female Residents

Oladeji Saheed Busari, Saheed Opeyemi Usman, Ndumiso Tshuma, Olusola John Fatunmbi, Ibiwumi Nafisat Usman, Afusat Adesina

Asian Journal of Medicine and Health, Page 1-7
DOI: 10.9734/AJMAH/2017/36472

Background: Breast cancer is the commonest of all cancers and a leading cause of cancer deaths in women worldwide, a situation that can be predicated upon by knowledge inadequacies and fundamental cancer prevention strategies. This study was therefore carried out to determine the screening trend among female residents in South-Western Nigeria and determine the significant effect of education and occupation on the screening of breast cancer.

Methods: This cross sectional study was carried out four South-Western States (Osun, Ekiti, Ogun & Lagos) in Nigeria. The target population was 20 years and above female residents of the states. Data was collected by trained volunteers and supervised by appointed supervisors, by a face-to-face interview. All data were statistically analysed, using statistical package for the social sciences (SPSS) windows version 23.0 software and statistical test of significance was performed with Chi-Square test while multiple comparisons was done using Post Hoc Bonferroni test.

Results: A total of 620 consenting respondents participated in the study with a mean age ± SD is 30.93 ± 8.03 years. 359 (57.9%) of them knew breast cancer doesn’t always produce symptoms, 392 (63.2%) knew how to perform breast self-examination (BSE) while 364 (58.7%) have ever done the BSE. The main factor significantly associated with breast cancer screening were educational status (χ² = 196.48, df = 3, P = 0.001) and occupation (χ² = 172.95, df = 4, P = 0.001). The odds for performing breast self-examination (BSE) for women who know that breast cancer does not necessarily produce symptoms especially in the early stages is low (OR: 0.77, 95% CI: 0.28 – 0.92).

Conclusion: This study shows inadequate screening practices even among those aware of the various screening techniques indicating the urgent need for re-orientation and development of more efficient educational programs particularly in schools and communities aimed at reducing the identified barriers to breast cancer screening practices and early detection in order the stem the tide of the disease, the arising mortality and make available timely treatment options.

Open Access Original Research Article

The Diagnostic and Prognostic Value of Mitral Annular Plane Systolic Excursion (MAPSE) as an Echocardiographic Indicator of Myocardial Dysfunction in Sepsis and Septic Shock

Mohamed Saleh Gomaa, Maher A. El-Amir, Heba M. Zein El-Abedin, Gomaa Abdel-Razik, Eman M. Ezzat

Asian Journal of Medicine and Health, Page 1-10
DOI: 10.9734/AJMAH/2017/36145

Objectives: Validation of mitral annular plane systolic excursion (MAPSE) as a rapid easy marker of left ventricle (LV) systolic function in general, and as an independent predictor of systolic function and mortality among patients with septic shock.

Background: Sepsis-induced myocardial dysfunction is one of the major predictors of morbidity and mortality in sepsis. Cardiac ultrasonography has become an indispensible tool in ICU for management of hemodynamically unstable critically ill patients, and MAPSE has been suggested as a surrogate measurement for LV function.

Methods: Prospective analysis of 50 septic shock patients by transthoracic echocardiography was carried out. MAPSE, LV ejection fraction (LVEF) measured by modified Simpson’s method, and mitral annular systolic velocity by tissue Doppler imaging TDI were measured every other day for 1 week, and they were correlated with cardiac injury biomarkers and mortality predictors.

Results: MAPSE values correlated significantly with sequential organ failure assessment score (SOFA score) among survived and non-survived patients (average; r – 0.95 with p-value <0.001 and average; r – 0.85 & 0.84 with p-value <0.001 respectively), with high percentage of non-survivor group had MAPSE ˂ 9 mm, on the other hand high percentage of survivor group had MAPSE ≥ 9 mm, and regarding receiver operating characteristic (ROC) curves for mortality prediction; MAPSE was (95.5% sensitivity, 67.9% specificity, and 92% accuracy for cut-off value of ≤ 8.8 mm). Also, it was found that there was statistically significant positive correlation with p-value <0.05 between MAPSE with LVEF and systolic mitral annular velocity TDI S' values, with high percentage of LVEF value ≤ 50% had MAPSE ˂ 9 mm and TDI S' ≤ 8 cm/sec, on the other hand high percentage of LVEF value > 50% had MAPSE ≥ 10 mm and TDI S' > 8 cm/sec, and regarding ROC curve for prediction of LVEF of value ≤ 50%; MAPSE measurement was (98.1% sensitivity, 90.9% specificity, and 96.4% accuracy for cut-off value of ≤ 9 mm).

Conclusion: MAPSE value is thought to be an independent tool for LV systolic function assessment generally, as well as myocardial injury in patients with sepsis induced myocardial dysfunction, and also a predictor of mortality in patients with severe sepsis and septic shock.

Open Access Original Research Article

Seroprevalence of Helicobacter pylori Ig G Antibody and Risk Factors in Hypertensive Patients at Dschang District Hospital in Cameroon

Jean-de-Dieu Tamokou, Yvette Alvine Tonleu Guimtsop, Martin Ernest Ndebi, Vanessa Linda Nzesseu, Arsène Kamamo Djokge, Jules-Roger Kuiate

Asian Journal of Medicine and Health, Page 1-9
DOI: 10.9734/AJMAH/2017/36249

Aims: Growing evidence suggests that certain extragastric diseases were associated with Helicobacter pylori infection. This study aimed to determine the seroprevalence of H. pylori Ig G antibody and risk factors among hypertensive patients at Dschang District Hospital in Cameroon.

Place and Duration of Study: Department of Biochemistry and District Hospital of Dschang, between November 2015 to March 2016.

Methods: A cross-sectional study was carried out on 158 consenting patients of average age 57.21 ± 10 years attending the hospital for medical check-up or admitted in the hospital. Two blood pressure measurements and the determination of anti-H. pylori IgG antibody by the indirect enzyme-linked immunosorbent assay (ELISA) technique, enabled us to distinguish four groups of patients. A questionnaire survey was administered to study participants and potential risk factors for H. pylori exposure sought. The variables were included into a multivariate logistic regression model, and the association of the potential risk factors with the studied pathologies was expressed as odds ratio (OR) with 95% confidence intervals (CIs). The Chi-square test was used to compare frequencies of risks factors in the various groups. SPSS 20.0 was used for statistical analyses. A p < 0.05 was considered significant for all analyses.

Results: The seroprevalence of anti-H. pylori IgG antibody was significantly higher in hypertensive patients than in controls (44.89% versus 33.33%; p = 0.029; OR = 2.43). Among the risk factors evaluated, sex (p = 0.001; OR = 1.269) and alcohol intake (p = 0.001; OR = 1.235) were observed to be independent risk factors of hypertension while the habit of sharing cutleries (p = 0.043; OR = 2.337) and family history of gastric pains (p = 0.001; OR = 39.0) were predictors of H. pylori infection. Finally, obesity was an independent predictor of hypertension (p = 0.0204; OR = 5.149) and H. pylori infection (p = 0.047; OR = 2.042).

Conclusion: Based on these results, it is conceivable that H. pylori infection and the identified risk factors can be reliable indicators for the assessment of cardiovascular problems such as hypertension.