Factors influencing compliance in patients with tuberculosis on directly observed therapy at Ile-Ife, Nigeria

Background: Increased morbidity and mortality of tuberculosis have been blamed on neglect of the human dimension of tuberculosis control. One of such factors included in human dimension is non-compliance, a behavioural parameter, which has led to the emergence of multi-drug resistant tuberculosis, and poor treatment outcome.Objective: To explore the impact of directly observed therapy (DOT) on compliance and the factors influencing it.Design: A retrospective study.Setting: Chest clinic of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.Methods: Directly observed therapy (DOT) was employed. Records of the socio-demographic characteristics, treatment categories, complications developed, results of investigations, level of compliance and treatment outcome for the patients were kept. The data for thepatients seen between May 1996 and April 1997 were retrieved and analysed. Those that complied were compared with those that did not comply.Results: One hundred and ninety nine patients comprising ninety one males and 108 females, were seen during the period .They were mostly between the ages of 16 years and 45 years(mean ± SD = 31.7±14.98). One hundred and fifty eight (73%) complied and all of themwere cured. The only factor that significantly influenced rate of compliance was proximity to the chest clinic.Conclusion: DOT improves the rate of compliance. No socio-demographic factors considered significantly influenced the rate of compliance under DOT, and as such they are not reliablepredictive factors. Locating chest units in the existing primary health care facilities will improve the rate of compliance with antituberculosis therapy. More attention should be paid to behavioural aspect of tuberculosis control

The value of plain abdominal radiographs in management of abdominal emergencies in Luth

No Abstract

Ultrasonic measurement of the liver size in normal adult Nigerians at the University of Port Harcourt Teaching Hospital

Background: Clinically, liver size is estimated by palpation and percussion. However this method is not without limitation, which is overcome by use of ultrasound scan. The purpose of this study is to establish a normal range of liver size for adults in Nigeria through ultrasound imaging to assist in clinical evaluation of the liver and also to highlight factors influencing liver size in the adults. Methods: Measurement of the liver size of 255 adults were done using ultrasound scan. The largest craniocaudal and anterioposterior dimensions were taken at the midclavicular line. Height and weight of the patients were also recorded. Data was analysed using SPSS 14.0 for windows evaluation version. Results: Two hundred and fifty-five normal subjects who met the laid down criteria for normal liver were studied. The age range was 16 - 65 years with mean age of 34.68 ± 11.84 years. The mean craniocaudal dimension decreases as the age range increases while the mean anterioposterior dimension increases with age range. Weight was found to have better correlation for both craniocaudal and anterioposterior dimensions followed by height. Conclusion: Ultrasound measurement of liver size is non-invasive and enables direct visualization of the liver. The present study suggests that both the craniocaudal and anterioposterior dimensions should be measured when evaluating liver size with ultrasound scan. Gender and weight of patient should be taken into consideration when assessing the size of the liver using ultrasound scan as these factors affects the size of the liver. Keywords: Ultrasound, Liver size, Height, Weight, Ag

Hysterosalpingography and Risks of HIV Dissemination in Women

Hysterosalpingography (HSG) represents an important imaging procedure in the investigation of infertility and may be associated with high pregnancy rate as a therapeutic effect. Whereas less traumatic and infection-free techniques of HSG have been embraced in the developed countries using disposable catheters, the traditional method which employs sterilizable metal cannula with potential to cause tissue laceration and infection dissemination continues to be used in Nigeria. This report attempts to discourage the use of such shared instrumentation in order to prevent horizontal dissemination of HIV infection among female patients. Over a seven month period, 746 HSGs were performed using predominantly sterilizable metal cannula or disposable catheters when the former fails. Analysis of the age of patients, type of instrumentation and outcome of the HSG procedure was undertaken and tabulated. The HSG workload out of a total radiologic procedure of 4039 is 746 (18.47%). The mean age of the patients is 33 years. Of the 707 HSGs carried of with sterilizable metallic cannula, contrast medium reflux into the pelvic veins was recorded in 133 (17.83%) cases, whereas this phenomenon was absent in instrumentation with disposable catheters. Venous intravasation during HSG procedure carries a risk of horizontal dissemination of HIV virus when sterilizable metallic cannula is employed. This may be prevented through the use of disposable catheters. Keywords: Hysterosalpingography, HIV, Infection, RiskNigerian Hospital Practice Vol. 2 (2) 2008: pp. 37-4

Factors influencing compliance in patients with tuberculosis on directly observed therapy at Ile-Ife, Nigeria

Background: Increased morbidity and mortality of tuberculosis have been blamed on neglect of the human dimension of tuberculosis control. One of such factors included in human dimension is non-compliance, a behavioural parameter, which has led to the emergence of multi-drug resistant tuberculosis, and poor treatment outcome

Relationship between C-Reactive Protein and Body Mass Index in Nigerians with Type II Diabetes Mellitus

Background. C-reactive protein is an acute-phase protein synthesized in the liver and its release is stimulated by cytokines (interleukin 6 and tumour necrosis factor alpha). Baseline levels of C-reactive protein in apparently healthy men and women predict long-term risk of a first myocardial infarction. In older men and women, elevated level CRP was found to be associated with a 10-year risk of coronary heart diseaseregardless of the presence or absence of cardiac risk factors. Studies have shown a significant correlation between CRP and body mass index (BMI). But data regarding CRP and BMI in our Nigerian population is lacking hence the decision to conduct this study.Method. The study design was cross-sectional comprising 125 consecutive subjects consisting of 75 patients with type II diabetes mellitus with or without hypertension attending medical outpatient clinic of the Obafemi Awolowo University Teaching Hospitals complex (OAUTHC) Ile Ife, Osun State (in southwestern Nigeria), and 50 apparently healthy age- and sex-comparable controls from the hospital staff and patient relatives who were themselves not relatives of the study patients were recruited. Measurement of C-reactive protein was based on the principle of solid phase enzyme-linked immunosorbent assay (ELISA).Results. Body mass index differed significantly between patients and controls as well as the C-reactive protein level. There was a positiveand significant correlation between serum CRP and body mass index among both patients and controls.Conclusion. C-reactive protein was found to be significantly higher in diabetics compared to controls. In addition, there was a positive andsignificant correlation between body mass index and C-reactive protein even after adjusting for hyperglycaemia.Key words: C-Reactive Protein, Body Mass Index, Type II diabetes Mellitus

Perceptions of inhibitors and facilitators for adhering to hypertension treatment among insured patients in rural Nigeria: a qualitative study

Universal health care coverage has been identified as a promising strategy for improving hypertension treatment and control rates in sub Saharan Africa (SSA). Yet, even when quality care is accessible, poor adherence can compromise treatment outcomes. To provide information for adherence support interventions, this study explored what low income patients who received hypertension care in the context of a community based health insurance program in Nigeria perceive as inhibitors and facilitators for adhering to pharmacotherapy and healthy behaviors. We conducted a qualitative interview study with 40 insured hypertensive patients who had received hypertension care for > 1 year in a rural primary care hospital in Kwara state, Nigeria. Supported by MAXQDA software, interview transcripts were inductively coded. Codes were then grouped into concepts and thematic categories, leading to matrices for inhibitors and facilitators of treatment adherence. Important patient-identified facilitators of medication adherence included: affordability of care (through health insurance); trust in orthodox "western" medicines; trust in Doctor; dreaded dangers of hypertension; and use of prayer to support efficacy of pills. Inhibitors of medication adherence included: inconvenient clinic operating hours; long waiting times; under-dispensing of prescriptions; side-effects of pills; faith motivated changes of medication regimen; herbal supplementation/substitution of pills; and ignorance that regular use is needed. Local practices and norms were identified as important inhibitors to the uptake of healthier behaviors (e.g. use of salt for food preservation; negative cultural images associated with decreased body size and physical activity). Important factors facilitating such behaviors were the awareness that salt substitutes and products for composing healthier meals were cheaply available at local markets and that exercise could be integrated in people's daily activities (e.g. farming, yam pounding, and household chores). With a better understanding of patient perceived inhibitors and facilitators of adherence to hypertension treatment, this study provides information for patient education and health system level interventions that can be designed to improve compliance. ISRCTN4789440