West Africa Journal of Medicine

EDITORIAL: Renal Replacement Therapy and Kidney Transplantation: Addressing Gaps in Access and Outcomes

G. E. Erhabor — Fri, 30 May 2025 00:00:00 +0000

Each new issue of the journal represents more than a collection of articles; it reflects the collective effort of a community committed to advancing health. In these pages, readers will find new perspectives on persistent challenges, evidence to guide better practice, and ideas that point toward future innovations. Such progress is only possible through the tireless work of our authors, whose scholarship we are privileged to share, and the discerning contributions of our reviewers, who help shape and improve every manuscript. We remain grateful for their dedication, which sustains the quality and credibility of this journal.

This issue presents contributions spanning medical and surgical disciplines. Kuku-Kuye et al., in a study in Lagos, Nigeria, reported that antepartum risk stratification significantly predicts obstetric interventions and adverse neonatal outcomes, reinforcing the importance of early risk identification and adherence to WHO antenatal guidelines. Bamikefa et al. demonstrated that histologic activity and chronicity indices in glomerulonephritis correlate strongly with renal function, emphasizing their prognostic utility and relevance for guiding management. In a qualitative study, Wuraola and co-workers examined the lived experiences of colorectal cancer patients with colostomies, identifying profound psychosocial and financial challenges and highlighting the need for comprehensive perioperative support, while Okwuonu et al. provided a report of their seven-year experience of kidney transplantation at a tertiary institution in South-east Nigeria. Collectively, these studies, alongside others featured in this edition, offer valuable evidence to inform clinical practice and policy, with direct implications for improving health outcomes in the region.

The burden of chronic kidney disease is increasingly becoming a major public health concern in developing countries, including the West African region.^1,2 The rising prevalence of hypertension, diabetes, chronic glomerulonephritis, and infectious diseases, coupled with limited preventive strategies and late presentation, has created a growing demand for renal replacement therapy (RRT), which includes dialysis and transplantation.^1-4 Yet, access to these life-saving interventions remains grossly inadequate due to a combination of various factors. These include economic, infrastructural, policy-related, and sociocultural barriers. Haemodialysis services are concentrated in major urban tertiary hospitals, leaving vast rural populations underserved. Even where dialysis is available, treatment is often inconsistent, with poorly maintained machines, unreliable water treatment systems, and frequent supply chain disruptions for essential consumables. The financial burden is overwhelming, as most patients pay out-of-pocket for each dialysis session. Many begin treatment but are unable to sustain it, leading to high early mortality.^3-5

Kidney transplantation has made some progress in West Africa, though on a limited scale. Nigeria, Ghana, and Senegal have documented successful kidney transplants. Despite these achievements, the number of procedures remains strikingly low.^5-7 Most West African programs still rely exclusively on living-related donors, as the absence of enabling legislation and organ-sharing networks has stalled the development of deceased donor programs. Moreover, the long-term sustainability of transplantation is threatened by the high cost and inconsistent availability of immunosuppressive therapy, which frequently results in graft failure even after technically successful procedures.^5-7

The obstacles to improved access are multifaceted. Chief among them is the overwhelming economic burden. With no structured government subsidies or comprehensive health insurance coverage for RRT, the majority of patients are unable to afford treatment. Policy gaps are equally glaring. Few countries in West Africa have enacted comprehensive transplant legislation, and there are no national organ registries or transparent allocation systems. This vacuum has left the region heavily dependent on living donation, while also exposing it to risks of commercial transplantation and transplant tourism, with all their ethical and equity-related implications.^5-7

The report by Okwuonu et al., published in this issue, detailing their seven-year experience with kidney transplantation, underscores both the prospects and persistent challenges in expanding access to renal replacement therapy. The retrospective review showed that 93 were evaluated, of whom 12 underwent transplantation, yielding a conversion rate of 13%. Financial constraints accounted for 40% of cases where transplantation could not be achieved. Among recipients, hypertension, hyperkalaemia, anaemia, and urinary tract infections were the most frequent acute complications, while cytomegalovirus infection, recurrence of native disease, chronic graft loss, and death were the key long-term adverse events.

The significance of the report is twofold. First, it demonstrates that with institutional commitment, strategic partnerships, and multidisciplinary collaboration, effective kidney transplantation services are feasible in our resource-limited environments. It also highlights the enduring barriers that must be addressed to transform such programs into large-scale, sustainable services. Chief among these barriers are financial access, with most patients unable to afford the cost of surgery and lifelong immunosuppression, and systemic challenges, including limited organ donor availability, inadequate supportive infrastructure, and the absence of comprehensive insurance coverage.

The way forward requires a deliberate and coordinated approach across multiple fronts. Governments must prioritize kidney disease within national non-communicable disease strategies, providing financial protection through subsidies and inclusion of RRT in health insurance schemes. Investments are urgently needed to expand dialysis services beyond tertiary centers, to establish functional peritoneal dialysis programs, and to strengthen transplant capacity. Training of nephrologists, surgeons, nurses, and allied health professionals should be scaled up, and regional collaboration in training and service delivery should be encouraged. Importantly, comprehensive legal and policy frameworks are required to enable ethical and transparent organ donation and transplantation, including the establishment of deceased donor programs and regional organ-sharing networks.

The recent introduction of a government-led subsidy program for dialysis in Nigeria, alongside the development of national guidelines for organ donation, are commendable milestones in the quest to improve renal care. However, their true impact will depend on sustained and effective implementation across the country. Importantly, such efforts should be scaled up and expanded to ensure wider coverage so that more patients can benefit equitably. Beyond dialysis, similar subsidies or insurance coverage mechanisms need to be extended to kidney transplantation, which remains the definitive therapy for end-stage kidney disease. Such policy expansion would not only improve survival and quality of life for patients but also reduce the long-term economic burden on families and the health system.

As this issue demonstrates, the challenges before us are significant, yet so too are the opportunities for innovation, collaboration, and progress. We hope that the insights shared here will inspire action-whether in research, clinical care, education, or policy-that ultimately advances health and well-being across our communities. We also encourage our readers, contributors, and partners to continue bringing forward rigorous scholarship and innovative ideas, so that together we can expand the frontiers of medical knowledge and strengthen healthcare for the future.

REFERENCES

Nweke M, Ado-Aghughu T, Daniels T, Imo U. Burden and distribution of chronic kidney disease in sub-saharan africa: a systematic review with meta-analysis. African Health Sciences. 2025;25(1):373-94.
Ying M, Shao X, Qin H, Yin P, Lin Y, Wu J, et al. Disease burden and epidemiological trends of chronic kidney disease at the global, regional, national levels from 1990 to 2019. Nephron. 2024;148(2):113-23.
Akwaboah PK, Somuah AA, Odonkor ST. Prevalence and distribution of non-communicable diseases in sub-Saharan Africa: the case of hypertension, diabetes, and chronic kidney disease/acute kidney injury. Central European Management Journal. 2022;30(4):1310-26.
Okoye O, Mamven M. Global dialysis perspective: Nigeria. Kidney360. 2022;3(9):1607-10.
Eke FU, Ladapo TA, Okpere AN, Olatise O, Anochie I, Uchenwa T, et al. The current status of kidney transplantation in Nigerian children: still awaiting light at the end of the tunnel. Pediatric Nephrology. 2021;36(3):693-9.
Kalyesubula R, Aklilu AM, Calice-Silva V, Kumar V, Kansiime G. The future of kidney care in low-and middle-income countries: challenges, triumphs, and opportunities. Kidney360. 2024;5(7):1047-61.
Bamgboye EL. Kidney transplantation in Sub-Saharan Africa: history and current status. Kidney360. 2023;4(12):1772-5.

ORIGINAL: Correlates of Histologic Activity and Chronicity Indices in Adult Patients with Glomerulonephritides: A Nigerian Picture

Fri, 30 May 2025 00:00:00 +0000

Background: Globally, glomerulonephritis with its diverse clinical manifestations and histologic attributes still maintains a dominant position among the myriads of aetiological culprits associated with the pathophysiologic course of chronic kidney disease. This study distinctively correlated the graded and scored histologic features observed in the glomerulus and tubulo-interstitium with clinical and biochemical features.

Methods: A hospital-based cross-sectional study of 70 adult patients who presented consecutively with features of glomerulonephritis was carried out. Renal biopsies were undertaken after renal function assessment. Light microscopy and immunoperoxidase staining utilising IgA, IgM, IgG and C3 antibodies were carried out on the biopsied renal tissues. The degree of glomerular, tubular, interstitial and vascular affectation were graded and scored. Total activity and chronicity indices were collated and their association/correlation with clinical parameters assessed.

Results: Male gender predominated (67.2%) with an overall mean age of 28.4 ±10.3 years. Statistically significant correlations were found between interstitial oedema with serum creatinine (r=0.35, p=0.003) and GFR (r=-0.38, p=0.004); interstitial infiltrate with serum creatinine (r=0.52, p<0.0002) and GFR (r=-0.70, p=0.002); total activity index with serum creatinine (r=0.60, p=0.0001) and GFR (r= -0.48, p = 0.004). Statistically significant correlations were also seen between total chronicity indices with serum creatinine (r=0.62, p=0.001) and GFR (r= -0.58, p<0.001).

Conclusion: Both activity and chronicity indices significantly influenced renal function. The higher they are, the lower the GFR and vice versa. These further buttress the need for aggressive management protocol for GN patients with higher indices to slow down renal function decline.

ORIGINAL: Antepartum Risk Stratification and Its Influence on Labour Interventions and Outcomes: A Retrospective Cohort Study

Fri, 30 May 2025 00:00:00 +0000

Background: Early identification of risk factors in pregnancy is essential to improving maternal and neonatal outcomes. High-risk pregnancies, characterized by maternal or fetal factors that increase the likelihood of complications, contribute significantly to maternal mortality, particularly in low- and middle-income countries (LMICs). This study examines the influence of antepartum risk stratification on labour interventions and outcomes among women in Lagos, Nigeria.

Methods: This retrospective cohort study included 507 women admitted to the labour ward at Lagos State University Teaching Hospital (LASUTH) from May 2019 to April 2022. Participants were classified as low-risk or high-risk based on antenatal clinical profiles, including sociodemographic, obstetric, and medical factors. Outcomes were assessed based on labour interventions (induction, augmentation, mode of delivery) and neonatal outcomes (APGAR scores, NICU admissions). Data was analyzed using descriptive statistics, chi-square tests, and logistic regression to identify factors associated with high-risk classification and outcomes.

Results: High-risk pregnancies constituted 17.6% of the cohort and were associated with younger maternal age, nulliparity, and higher antenatal care utilization. High-risk women had significantly higher rates of induction (14.6% vs. 1.2%), oxytocin augmentation (27% vs. 5.3%), and emergency cesarean delivery (39.3% vs. 23.4%). Neonates of high-risk pregnancies had lower APGAR scores and higher NICU admissions (25.8% vs. 3.8%, p < 0.001). Increased ANC attendance was significantly associated with high-risk classification.

Conclusion: High-risk pregnancies are associated with increased maternal and neonatal complications, highlighting the importance of early risk stratification and adherence to WHO guidelines for adequate antenatal care. Strengthening ANC services and timely interventions can improve outcomes in LMICs.

ORIGINAL: Clinical Characteristics and Predictors of Depression among the Older Adults Attending the Family Medicine Clinic of Usmanu Danfodiyo University Teaching Hospital Sokoto in Northwestern Nigeria

Fri, 30 May 2025 00:00:00 +0000

Background: Depression represents a major international public health problem for both developed and developing countries. It is associated with increased risk of morbidity, suicide, decreased physical, cognitive and social function, and greater self-neglect, which in turn is associated with increased mortality.

Objective: The study objective was to determine the clinical characteristics and predictors of depression among the elderly attending the family medicine clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Northwestern Nigeria.

Methodology: The study was a hospital-based cross-sectional study of 391 elderly participants in the family medicine clinic of Usmanu Danfodiyo University Teaching Hospital, recruited through systematic sampling technique. Data was collected using a pre-tested, structured interviewer-administered questionnaire, and Folstein (MMSE). The GDS-30 was used to screen for depression. BMI was calculated and data analyzed using SPSS version 20. Test of associations was done using the Chi-square test, and logistic regression was done; P < 0.05 was considered statistically significant.

Results: The prevalence of depression among the elderly was found to be 41.2%. Following logistic regression, being married (OR=0.559, 95% CI=0.321-0.974), bereavement in the last six months (OR=2.35, 95% CI=1.138- 4.480), poor subjective health status (OR=0.141, 95% CI=0.057-0.348), and abnormal BMI (OR=0.425, 95% CI=0.221-0.818) were found to be predictors of elderly depression in the study.

Conclusion: The prevalence of depression among older adults was high, and the study recommends early screening, detection and management of risk factors of depressive disorder in older adults by primary care physicians.

ORIGINAL: "Life without an Anus": Experience of Cancer Patients Living with Colostomy in South West Nigeria

Fri, 30 May 2025 00:00:00 +0000

Introduction: As the incidence of colorectal cancer increases in Nigeria, more patients will get colostomies. Previous studies of patients with colostomies in other African countries have reported significant decreases in quality of life. Understanding the experiences of Nigerian patients is crucial for designing interventions that ensure patients can maintain a high quality of life after colostomy. This study aims to explore the impact of colostomy on the quality of life of Nigerian patients.

Methods: Between August and December 2022, 16 in-depth interviews were conducted with patients who had undergone a colostomy for at least six months. Patients were identified through an institutional database of colorectal cancer patients at Obafemi Awolowo University Teaching Hospital in Southwest Nigeria.

Results: Patients overwhelmingly reported life-altering challenges related to their colostomy. Some of the most commonly reported challenges included social isolation, financial constraints, sexual dissatisfaction, and altered self-image. Patients also reported that they did not understand until after surgery what it would be like to live with a colostomy.

Conclusion: As the number of cancer patients with colostomies increases in Nigeria, it is important to address the social and financial barriers that patients face after having a colostomy.

ORIGINAL: Clinical and Ultrasonographic Correlates of Knee Pain in Patients with Type 2 Diabetic Mellitus in a Nigerian Tertiary Hospital

A. S. Aderibigbe, O. O. Ayoola , B. A. Kolawole, O. Esan — Fri, 30 May 2025 00:00:00 +0000

Background and objectives: To ascertain the prevalence of knee pain in type 2 diabetic mellitus (T2DM) patients and to compare associated structural ultrasonographic arthritic changes with non-diabetic controls. Associations between T2DM knee pain, clinical variables and ultrasonographic arthritic changes were also investigated.

Methods: Using a high frequency linear ultrasound probe (7.5-12MHz), both knees of 78 consecutive T2DM patients and 30 age and sex matched non-diabetic controls without knee pain were scanned.

Results: Seventy-eight T2DM patients and 30 controls with mean ages of 63.0±10.4years (M:F = 1:1.9) and 2.3±10.5years (M:F = 1:0.9) respectively were studied. Forty (51.8%) T2DM patient presented with unilateral or bilateral knee pain while clinical pes anserinus tendinitis bursitis syndrome (PATBS) was diagnosed exclusively in 8 female T2DM patients, constituting 10.0% of the total T2DM group. At least 1 positive ultrasonographic arthritic change was found in 98.5% T2DM knees with pain, 86.8% T2DM knee without pain, and 69.2 % control knees (p< 0.05). Independent predictors of knee joint pain are age >60 years (OR=3.5), obesity (OR=2.9), and medial meniscal protrusion (OR=8.7).

Conclusions: Ultrasonographic arthritic changes are highly prevalent in T2DM patients with and without knee pain. Independent predictors of knee joint pains are age > 60 years, obesity, and medial meniscal protrusion.

ORIGINAL: The Outcome of Laparoscopic Cholecystectomy at King Khalid Hospital, Hail, Saudi Arabia

R. A. S. Altwiher, N. J. Nwashilli, A. S. Alzaid — Fri, 30 May 2025 00:00:00 +0000

Background: Laparoscopic cholecystectomy has evolved to become the gold standard treatment of calculous and acalculous cholecystitis.

Aim: This research aims to study the demographics, indications, types of cholecystectomies (early/interval), length of hospital stays, conversion to open surgery, use of drains, complications, and outcomes.

Patients and methods: This was a retrospective, descriptive study of all cases of laparoscopic cholecystectomy carried out from 1st January 2023 to 31st December 2023 at King Khalid hospital Hail, Saudi Arabia. The case files of all the patients who had laparoscopic cholecystectomy were retrieved from the Oasis health information management system of the hospital. Written informed consent was obtained from each patient before surgery. Ethical approval was obtained before embarking on the study. Information regarding demographics, indications and types of cholecystectomies, length of hospital stays, conversions to open surgery, use of drains, complications and mortality were analyzed with Statistical Package for Social Sciences version 26.

Results: A total of 351 cases of cholecystitis had laparoscopic cholecystectomy. There were 248 (70.7%) females and 103 (29.3%) males. The mean age of the patients was 39.5 ± 1.2 years. There was conversion to open cholecystectomy in four (1.1%) cases. The average duration of hospital stay was 1.5 ± 1.5 days. There was neither a case of bile duct injury nor mortality.

Conclusion: The outcome of laparoscopic cholecystectomy was good with no major morbidity or mortality.

ORIGINAL: Utility of Cardiac Troponin I as a Marker of Severity in Non-Ischaemic Heart Failure

Fri, 30 May 2025 00:00:00 +0000

Background: Biomarkers are crucial for assessing the severity of heart failure (HF) and monitoring its treatment. Cardiac troponin I (cTnI) has traditionally been used as a marker for myocardial injury but its role in non-ischemic heart failure (NIHF) remains unclear.

Objectives: This study was aimed at determining the relationship between cTnI and left ventricular function and geometry in NIHF patients.

Methods: This was a cross-sectional comparative study that recruited 60 NIHF patients and 60 controls from the cardiology unit in a tertiary hospital. All participants had cTnI assay and transthoracic echocardiography done to assess left ventricular function and geometry. Data was analysed using Statistical Package for Social Sciences (SPSS) version 23. The level of statistical significance was fixed at p value < 0.05.

Results: The mean age of patients with NIHF was 50.0±12.6 years versus 50.3±12.0 years for controls (p=0.456). The mean serum cTnI level was 358.52±56.60ng/L in NIHF patients versus 218.54±36.01ng/L in the controls (p <0.001). Serum cTnI had a moderate negative correlation with ejection fraction (EF) in NIHF patients (R= -0.70, R2 = 0.492); and a positive correlation with left ventricular mass index (LVMI) (R= 0.12, R2 = 0.015). Mean cTnI levels increased with worsening grade of diastolic dysfunction in NIHF patients. Higher levels of serum cTnI was associated with worse New York Heart Association (NYHA) class of HF (p <0.001).

Conclusion: Elevated serum cTnI level was associated with worsening clinical and echocardiographic indices of left ventricular function in NIHF patients suggesting that it is an important surrogate marker for worsening HF.

ORIGINAL: Prevalence of Acute Heart Failure and The Role of N-Terminal Prohormone Brain Natriuretic Peptide among Acute Dyspnoeic Patients in the Emergency Room

O. B. Olaoye, E. A. Ajayi, O. A. Busari, O. E. Ojo, A. O. Adeoti , O. Adewuya — Fri, 30 May 2025 00:00:00 +0000

Background: Acute dyspnoea (AD) is one of the most common presentations in the emergency room (ER). Its myriads of confusing differentials which include acute heart failure (AHF) has significant mortality and morbidity, and specific mode of treatment. The measurement of NT-proBNP among AD patients when AHF is being suspected will aid early diagnosis, treatment and improve outcomes.

Objective: To estimate the prevalence of AHF and usefulness of NT-proBNP among AD patients at the Ekiti State University Teaching Hospital's (EKSUTH) ER.

Method: This was a cross-sectional study. Persons aged 18 years or older with AD in the ER of the EKSUTH, Nigeria were recruited. The patients were sub-categorized into heart failure as a cause of AD (HFAD) and non-heart failure as a cause of AD (nHFAD). NT-proBNP was assayed alongside ECHO parameters for the participants.

Results: There were 143 cases and 72 matched controls. The mean age of patients was 56.96± 13.5yrs while that of the controls was 56.17± 14.5yrs (p=0.685). Seventy-seven patients (54%) had AHF while the remaining 46% were dyspnoea of non-cardiac origin. Pneumonia, COPD, asthma and PE accounted for 33.57%, 8.40%, 2.80% and 1.40% respectively. The median NT-proBNP level was higher (p<0.001) in the AD patients compared to controls; 592.0 vs 37.50 pg/mL. The median NT-proBNP level was higher in the HFAD group than those with nHFAD and the controls (2885.40 vs. 128.70 and 37.50 pg/mL, P<0.001). NT-proBNP levels inversely and moderately correlated with ejection fraction (EF) (ρ= 0.68, p<0.001). It directly and moderately correlated with HF severity using the NYHA functional classification (ρ=0.50, p=0.017). An age-independent NT-proBNP cut-point level of 305 pg/mL recorded 93.5%, 88.3%, 45.3% and 99.2% for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) respectively.

Conclusion: AHF is the major cause of AD in ER. In AHF patients, NT-proBNP correlated inversely well with EF and NYHA functional classification, and has high sensitivity and NPV.

ORIGINAL: Predictors of Sleep Quality in Older Persons Attending the Outpatient Clinics in a Tertiary Hospital in Nigeria

O. A. Akinola, E. A. Etukumana, U. M. Morgan — Fri, 30 May 2025 00:00:00 +0000

Background: Good quality sleep is critical to human functioning as decline in sleep quality has been linked with health issues. One of the factors that has been identified with decline in sleep quality is increasing age, making older persons at risk of significant deleterious consequences on their physical, social, and mental spheres of well-being when they have poor sleep quality.

Objectives: This study aimed at determining the predictors of sleep quality among older persons aged 60 years and above attending the outpatient clinics of a tertiary hospital in Uyo, South-South Nigeria with a view to suggesting appropriate recommendations for health improvement of participants and clinical practice, where necessary.

Methodology and methods: This was a cross-sectional study involving two hundred and fourteen (214) respondents. Those who met the inclusion criteria were interviewed with the aid of a semi- structured questionnaire containing items on socio-demographic characteristics, clinical data, and items from the Pittsburgh sleep quality index. Data was analysed using Epi info® version 3.5.1.

Results: Of the 214 respondents recruited, the prevalence of good sleep quality was 63.1% with a higher rate of poor sleep quality observed in males (57%). Factors affecting sleep quality after bivariate analysis in this study were age group (70-74 years), polygamous family type, significant stress, sleep problems, chronic medical illness, routine medication, high blood pressure, overweight and obesity. However, when multiple logistic regression was done on these factors, family type, sleep problems, and chronic medical illness were still statistically significant.

Conclusions: More than one-third of the older persons had poor quality of sleep in this study, and the predictors of sleep quality were family type (polygamous), sleep problems, and chronic medical illness. Therefore, there is need for a careful routine assessment of sleep among older persons and this should include comprehensive sleep history as well as evaluation and treatment of various co-morbidities in order to improve sleep quality among them.

ORIGINAL: Performance and Outcome of Pioneering Kidney Transplantation in a Resource-Constrained Setting in Southeast Nigeria

Fri, 30 May 2025 00:00:00 +0000

Introduction: Kidney transplantation is the optimal treatment for improving survival and quality of life for patients with end-stage kidney disease. There was no kidney transplant surgery and acute transplant care services in Southeast Nigeria until 2017 when our institution commenced kidney transplant surgery and acute transplant care. This study aims to share our first eight year experience including graft and patient outcome.

Objectives: To obtain the transplant rate, short and long term complications and the graft and patient survival over an eight year period in a tertiary hospital in Southeast Nigeria.

Method: A retrospective review of the transplant register for patients referred to the kidney transplant unit over an eight year period from January 2017 to January 2025.

Result: Complete data for ninety-three patients were analyzed. Out of these, twelve were transplanted giving a transplantion rate of 13%. Financial constraint is the leading reason (40%) for failure to get a kidney transplant done. Hypertension, hyperkalemia, anemia and urinary tract infection were the leading acute complications encountered while cytomegalovirus infection, recurrence of native disease, chronic graft loss and death were the major long term complications. The three-month, one-year, three-year and five-year patient survival in our program were 100%, 90%, 80% and 80% respectively while the graft survival were 90%, 90%, 70% and 60% respectively.

Conclusion: The transplant conversion rate is low and a review of atient selection criteria will improve access kidney transplant. Acute complications were treatable in most cases. The patient and graft outcomes appear similar with other centres in Nigeria.