Community perception of quality of health care received and client satisfaction in Lagos, Nigeria

Background: Quality of health care and client satisfaction are key elements in improving the performance of health systems. A community-based assessment was conducted to determine the level of client satisfaction and the perception of the quality of services received by citizens of Lagos State.Methods: A descriptive cross-sectional study using both quantitative and qualitative methods, was conducted in four local government areas of Lagos State. Respondents were selected by multi-stage sampling technique. The survey instruments included an interviewer-administered, pre-tested questionnaire and a 10-itemed focus group discussion guide.Results: Two thousand respondents with a mean age of 37.6±10.21 years were recruited. Almost all respondents (98%) rated the health facilities to be clean, 96% felt they received effective treatment from their providers. Six out of ten respondents rated the waiting time to be short and 60% felt that most drugs were available. Eight-five percent opined that the quality of care received was good and 95% were satisfied with the services received. There was a significant correlation between quality of care and client satisfaction (ρ=0.145, p=0.001). Short waiting time was predictive of client satisfaction (OR=13.9, 95%CI, 5.68-33.33, p<0.001) and confidence in health care providers was predictive of both client satisfaction (OR=3.489, 95%CI, 1.554-7.835, p<0.001) and perception of good service quality (OR=2.234, 95%CI, 1.509-3.308, p<0.001).Conclusion: Adequate attention needs to be paid to factors affecting client satisfaction and perception of good service quality.Keywords: Quality; Client satisfaction; Health services; Health systems; Lago

Cervical Cancer Awareness and Screening Uptake among Rural Women in Lagos, Nigeria

Background: Cervical cancer is the most common cause of female genital cancer and female cancer deaths in developing countries such as Nigeria. The most recent government estimates put the number of new cases at 25,000 per year. According to the latest global estimates, 493, 000 new cases occur each year and 274,000 women die of the disease annually. This study therefore determined the awareness, knowledge and use of cervical cancer screening services among rural women in Lagos State, Nigeria.Method: A cross sectional, descriptive study design was adopted and a total of 400 women were studied. Data was collected using a structured, interviewer-administered questionnaire. The questionnaire elicited information about socio-demographic characteristics, awareness, knowledge and use of screening services. Univariate and bivariate analyses were done with Statistical Package for Social Sciences (SPSS) version 16. Significance level at 5%Results: Age range of study participants was 25-65years and a mean age of 38.9± 9.51 years. Most of the respondents (85.0%)were not aware of cervical cancer. However, amongst those who were aware of cervical cancer, 66.7% got the information from the media. Only a few (13.3%) of the respondents have ever been screened and none of the screening was in the last 3 years. Majority (86.7%) of the respondents expressed willingness to undergo cervical cancer screening.Conclusion: There was low awareness of cervical cancer and screening uptake among the respondents and the overall knowledge was equally poor. However, the respondents showed a strong willingness for screening. There is need for community education and awareness among the rural women at large as this would engender a more positive attitude and increased use of screening services

Utilization of health facilities and preferred places of treatment for common health conditions in Lagos, Nigeria

Background: When people are ill, the options for health-seeking behavior are shaped by several factors. Understanding these options is likely to contribute to early treatment and better outcomes. The objective of this study was to investigate the utilization and preferred places for treating common health problems in Lagos, Nigeria. Methods: A cross-sectional survey was conducted using both an interviewer administered questionnaire and focus group discussions to obtain data. Participants were recruited through multi-stage sampling methods from four local government areas in Lagos State. Conditions of interest included fever in children, cough, diarrhoea and vomiting and pregnancy care. The Statistical Package for Social Sciences (SPSS) version 22 software was used for analysis while the qualitative data was analyzed with ATLAS.ti software version 7. The level of significance was set at p< 0.05. Results: Two thousand participants were recruited. The mean age was 37.6±10.21years. Government hospitals were the most frequent usual source of health care (41%). Perceived effectiveness of treatment, speed of service and low cost were main reasons for these choices. Other sources of care such as drug store, nursing homes and trado-medical facilities were preferred more frequently by more than a third of respondents for most conditions except for pregnancy care. Primary Health Care centers were the least preferred sources of care. Conclusion: Primary Health Care centres were the least utilized sources of care. Increased advocacy is a recommended strategy to improve early presentation to health facilities

Antihypertensive use, prescription patterns, and cost of medications in a Teaching Hospital in Lagos, Nigeria

Introduction: Hypertension has been reported as the strongest modifiable risk factor for cardiovascular morbidity and mortality.Aims: The aim of the study was to identify the most prescribed antihypertensive drugs, its patterns, comorbidities, cost of medications, and laboratory investigations.Settings and Design: This study was a cross‑sectional, descriptive study of hypertensive patients conducted at the Lagos State University Teaching Hospital, Ikeja.Subjects and Methods: A total of 200 case notes were retrieved from the medical records unit over a period of 8 weeks. Information on antihypertensive prescriptions and comorbidities was retrieved. The average cost of medications and laboratory investigations was calculated.Statistical Analysis Tool Used: SPSS software version 16.Results: The mean age of the patients was 58.44 ± 12.65 years. Of the 200 patients, 5 (2.5%) were on monotherapy and 195 (97.5%) were on combination therapy. One hundred and twenty (60%) patients had comorbidities which included congestive heart failure 55 (27.5%), diabetes mellitus 22 (11%), hyperlipidemia 15 (7.5%), and cardiovascular disease 13 (6.5%). The various classes of antihypertensive drugs prescribed were diuretics 128 (64.0%), beta‑blockers 126 (63.0%), calcium channel blockers 106 (53.0%), angiotensin‑converting enzymes inhibitors 103 (51.5%), angiotensin receptor blockers 33 (16.5%), alpha blockers 9 (4.5%), and fixed drug combinations 2 (1.0%). The average cost per month of the antihypertensive medications was ₦ 2045 (US$10.2).Conclusions: Antihypertensive prescription pattern was in accordance with the seventh report of Joint National Committee on Prevention, Detection, Evaluation, and Treatment of high blood pressure. Community‑based insurance scheme should be encouraged and effective implementation of integrated noncommunicable diseases screening into the primary health care services would be helpful.Keywords: Antihypertensive drugs, comorbidities, costs, prescription pattern

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran