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

Adequacy of Bristol stool form scale in the assessment of stools by mothers of healthy infants in Ibadan, Nigeria

Background: An important complaint of mothers is the stool form of their infants. In the evaluation of stool forms, healthcare workers usually depend on mothers’ reports which are subjective and influenced by interpretation bias by health care personnel. There is therefore the need for an objective method of describing stool forms. In the present study, we evaluated the utility of the 7-point Bristol Stool Form Scale (BSFS) when used by mothers of healthy Nigerian infants. Materials and Methods: The mothers of 122 healthy infants delivered at term, with infants less than six months of age attending the Infant Welfare Clinics of two health facilities in Ibadan, South West, Nigeria for routine immunisation were enrolled. Mothers were requested to identify their child’s most recent stool form using the 7-point BSFS. Results: The mean ± SD age of the 122 study infants was 80 ±41.6 days (range 4-180 days). Eighty-eight (72.1%) infants were exclusively breastfed and 34 (27.9%) were on mixed feeding. Almost all (120; 98.4%) mothers felt that the BSFS adequately described their infants’ stools. The most commonly reported stool types were T ype 6 (56.7%) and T ype 7 (33.3%). There was no association between reported stool consistency and infant feeding type, level of maternal education and number of previous babies nursed. Conclusion: This study indicated that BSFS may be a reliable tool for mothers to describe stool consistency in healthy Nigerian infants

Vitamin D deficiency and insufficiency in Africa and the Middle East, despite year-round sunny days

Exposure to sunlight, specifically ultraviolet B (UVB), is essential for cutaneous vitamin D synthesis. Despite significant daily sunlight availability in Africa and the Middle East, persons living in these regions are frequently vitamin D insufficient or deficient. Vitamin D insufficiency (25-hydroxyvitamin D (25(OH)D) between 15 and 20 ng/mL (37.5 - 50 nmol/L)) has been described in various population groups, ranging from 5% to 80%. Risk factors include traditional dress and avoidance of sunlight exposure, and multiple dietary factors as a result of specific cultural beliefs. Vitamin D resistance due to calcium deficiency mechanisms has been described in similar population groups, which may lead to hypovitaminosis D. Should the new diseases related to hypovitaminosis D prove to be truly associated, Africa and the Middle East will become an epicentre for many of these conditions. Urgent attention will need to be paid to cultural dress and dietary behaviours if hypovitaminosis D is to be taken seriously. Should such factors not be correctable, new strategies for supplementation or food fortification will have to be devised.http://www.samj.org.zaam201

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

Urinary recovery of caffeine and its metabolites in healthy African children

Consumption of caffeine containing products is very popular in African children, particularly during ill health in the belief that caffeine promotes good health. This study aims to define the metabolism of caffeine, which takes place in the liver in a group of healthy Nigerian children. About 100 mg of caffeine was ingested after an overnight fast. Urine was collected before caffeine ingestion and over 12-hour periods for 36 hours in 13 healthy Nigerian children. The percentage of caffeine and metabolites recovered in urine was determined by high performance liquid chromatography.The total urinary caffeine and metabolites recovered over the 36-hour sampling period was 63.6%, with only 0.4% of the caffeine dose ingested recovered as unchanged caffeine during the same period. Insignificant amounts of 3,7-dimethyluric acid (0.2%), 3-methyluric acid (0.3%) and 1,3,7-dimethyluric acid (0.4) were recovered in the 36hour urine sample. This study also found that the N3-demethylation pathway was the principal pathway of caffeine metabolism accounting for 83.3% of the total metabolites recovered while C8-hydroxylation accounted for only 0.6% of metabolites recovered. The pattern of urinary metabolites recovered suggested that N3-demethylation is the principal pathway of caffeine metabolism in healthy African children and that small amounts of unchanged caffeine, as well as 3,7-dimethyluric acid, 3-methyluric acid and 1,3,7-dimethyluric acid were recovered during the sampling period

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

Ulcerative colitis in Nigerian children: A report of two cases and review of the literature

Ulcerative colitis (UC) is a relapsing, idiopathic chronic inflammatory disorder of colon characterised by ulcerations of the colon with bleeding, mucosal crypt abscesses and inflammatory pseudo polyps associated with abdominal pain with tenesmus and significant weight loss. Ulcerative colitis has rarely been reported in sub-Saharan African children. In this report we present 2 cases of ulcerative colitis i in Nigerian children confirmed by barium enema, colonoscopy and histology. A review of the current literature on ulcerative colitis is also discussed

Aflatoxin exposure in Nigerian children with severe acute malnutrition

Aflatoxin exposure is an important public health concern in sub-Saharan Africa as well as parts of Latin America and Asia. In addition to hepatocellular carcinoma, chronic aflatoxin exposure is believed to play a role in childhood growth impairment. The most reliable biomarker of chronic aflatoxin exposure is the aflatoxin-albumin adduct, as measured by ELISA or isotope dilution mass spectrometry (IDMS). In this report, we have used high resolution LC-MS/MS with IDMS to quantitate AFB1-lysine in an extremely vulnerable population of Nigerian children suffering from severe acute malnutrition. To increase the sensitivity and reliability of the analyses, a labelled AFB1-13C6 15N2-lysine internal standard was synthesized. AFB1-lysine concentrations in this population ranged between 0.2 and 59.2 pg/mg albumin, with a median value of 2.6 pg/mg albumin. AFB1-lysine concentrations were significantly higher in stunted children (median = 4.6 pg/mg) compared to non-stunted (1.2 pg/mg), as well as in children with severe acute malnutrition (4.3 pg/mg) compared to controls (0.8 pg/mg). The median concentrations were also higher in children with kwashiorkor (6.3 pg/mg) compared to those suffering from marasmus (0.9 pg/mg). This is the first report of the use of high-resolution mass spectrometry to quantitate AFB1-lysine in humans

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