Sensitivity and Responsiveness of Health Utility Indices (HUI2 and HUI3) Among Type 2 Diabetes Patients

Purpose: To assess the sensitivity and responsiveness of HUI2 and HUI3 among Type 2 diabetes patients.Methods: This cross-sectional study was conducted in two purposively selected Nigerian tertiary hospitals. Six hundred and thirty-eight (638) adult patients were surveyed following their consent using the HUI2 and HUI3 (HUI23S4En.40Q) questionnaire. Patients’ clinical characteristics such as age, comorbidity, severity of disease, and utilization of hospital resources were postulated a priori to be associated significantly with utility scores of HUI2 and HUI3. Student’s t-test and bivariate analyses were conducted to determine the diabetes-severity discriminatory ability of HUI2 and HUI3. The analyses were conducted with SPSS 14.0. A two-tailed significance level of 0.05 was used.Results: Older patients had lower quality of life than younger patients. The overall health deficit of increasing age for HU13 was -0.2950 and that of overall HUI2 was -0.1553. The respondents without eye problem had higher quality of life than those with eye problem, in both HUI3 and HUI2 utility scores. Stroke was the most important patients’ characteristic that negatively affected HRQOL. Patients with duration of diabetes > 4 years had lower quality of life scores than their counterparts (≤ 4years).Conclusion: Health Utility Index Mark 2 and Mark 3 were sufficiently sensitive and responsive to diabetes severity among Type 2 diabetes patients.Keywords: Health utility index, HUI2, HUI3, Quality of life, Diabetes

The Construct Validity of an Instrument for Measuring Type 2 Diabetes Self-Care Knowledge in Nigeria

Purpose: To develop an instrument (DSCKQ-30) for measuring type 2 diabetic patients’ knowledge of self-care practices.Methods: A 30-item questionnaire (DSCKQ-30) consisting of close ended questions was developed for this study. DSCKQ-30 was self administered to a cross-section of randomly selected 400 ambulatory adult diabetic patients (≥ 18 years), who were attending endocrinology clinics at the hospitals included in this study. The sex distribution for female and male was 56.7 and 43.3% respectively. Factor analysis and item analysis were performed to test the construct validity and reliability of the instrument. Item performance was measured by item discrimination (item-to-total correlation) and percent correctness (%C).Results: The response rate was 78.5%. Factor analysis identified three scales of knowledge of self-care management. Chronbach’s alpha of the 30 questionnaire items was found to be 0.89. The item-to-total correlation coefficients and ranges for component 1 - 3 were 0.36 (0.25 - 0.48), 0.28 (0.23 - 0.35), and 0.34 (0.23 - 0.41), respectively, with overall average of 0.33 (0.23 - 0.48). Items percent correctness (% C) ranged from 16.7 to 86.7 % with an overall average of 55.6 %. Item factor loadings averaged 0.62 for the total items; averages of the three scales ranged from 0.59 to 0.68.Conclusion: The DSCKQ-30 provided a quantitative measure of patient's knowledge of self-care practices.Keywords: Diabetes self-care knowledge, DSCKQ-30, Knowledge instrument, Nigeria

A review of Lassa fever outbreaks in Nigeria From 1969 to 2017: Epidemiologic profile, determinants and public health response

Introduction: Lassa fever outbreaks have occurred in Nigeria since the 1969 till date. This is in spite of the fact that the reservoir and modes of transmission have been known for all these years. This review aimed at describing the epidemiology and determinants of the Lassa fever outbreaks in Nigeria from 1969 to 2017 and the public health response to these outbreaks.Method: The guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used to conduct the review between May 2017 and January, 2018. We searched PubMed, Science direct, WHO library databases and Google Scholar for articles published from 1970 till January 2018. Other relevant websites such as those of the World Health Organization, Nigeria Centers for Disease Control and Prevention were searched for Lassa fever outbreak reports.Results: Twenty-six articles and reports were included in the final review. These described twenty-one outbreaks involving 5442 suspect cases, 768 confirmed cases and 631 deaths from suspected or confirmed Lassa fever. Thirty-two states and the Federal Capital Territory have ever recorded outbreaks of Lassa fever. Lassa fever cases now occur in various states in Nigeria all year round with dry season peaks. Nosocomial transmission has remained a consistent determinant. Public health responses have changed over time starting from predominantly case management in initial outbreaks to a centrally coordinated response supporting states and institutions over the years.Conclusion; Lassa fever outbreaks have increased in frequency and geographic spread with case fatality ratio remaining unacceptably high. The same determinants have persisted with nosocomial transmission a consistent factor. Public health response has consistently improved with the last two years showing the most coordinated response. We recommend that the definition of Lassa fever in the Nigerian Integrated Disease Surveillance and Notification System (IDSR) be revised to reflect the current reality to ensure better Lassa fever control.Key words: Lassa fever, Outbreak, Viral haemorrhagic fevers, Nigeria

Pharmacist intervention program to enhance hypertension control: a randomised controlled trial

Objective Studies have demonstrated that hypertension remains inadequately managed throughout the world, with lack of adherence to BP-lowering medication being a major factor. The aim of the present study was to evaluate if a pharmaceutical care program could improve antihypertensive medication adherence and blood pressure control. Setting This study was conducted in a secondary care hypertension/dyslipidemia outpatient clinic in the university teaching hospital of Cova da Beira Hospital Centre, Covilhã, located in the Eastern Central Region of Portugal. Method This report evaluates the pharmacist’s interventions during a prospective randomised controlled trial, from July 2009 to June 2010. Patients with diagnosis of essential hypertension attending the clinic for routine follow-up were randomly allocated either to a control group (no pharmaceutical care) or to an intervention group (quarterly follow-up by a hospital pharmacist during a 9-month period). The pharmacist interventions, aimed to increase medication adherence and blood pressure control, involved educational interventions and counselling tips directed to the patient. Main outcome measure Systolic blood pressure, diastolic blood pressure and blood pressure control (according to JNC 7 guidelines) assessed at the baseline visit and at the end of pharmaceutical care were the main outcome measures. Blood pressure measurements were performed by blinded nurses. Medication adherence was also evaluated, using a validated questionnaire at baseline and at the end of investigation. Results A total of 197 hypertensive patients were randomly assigned to the study (99 in the control group and 98 in the intervention group). Although there were no significant differences (P > 0.05) in both groups concerning mean age, gender, body mass index, and antihypertensive pharmacotherapy, blood pressure control was higher in the intervention group (P = 0.005) at the end of the study. Significant lower systolic blood pressure (−6.8 mmHg, P = 0.006) and diastolic blood pressure (−2.9 mmHg, P = 0.020) levels were observed in the intervention group. Medication adherence was also significantly higher in the intervention group at the end of the study (74.5% vs. 57.6%, P = 0.012).Conclusion Pharmacist intervention can significantly improve medication adherence and blood pressure control in patients treated with antihypertensive agents

Verification of the folkloric diuretic claim of Hibiscus sabdariffa L. petal extract

The folklorically acclaimed diuretic activity of the petal extract of Hibiscus sabdariffa was verified in saline-loaded albino rats (80 – 220 g; n=5) according to the method of De la Peurta Vazquez et al, 1989. A methanolic extract of the dried petals was prepared, and, upon lethal toxicity testing, was found to be very safe – LD50 >5,000 mg/kg, i.p. A metabolic assay was conducted using graded doses (5 mg/kg – 160 mg/kg) The urine produced over a period of six hours was collected per animal and its volume, density, pH, and electrolyte concentrations (Na+, K+ and C-) were determined using standard techniques. The effect of the most active dose level was compared to those of frusemide 3 mg/kg, mannitol 200 mg/kg, hydrochlorothiazide 10 mg/kg, and spironolactone 3 mg/kg. The extract was found to cause a dose-dependent increase in urine mobilization, which peaked at a dose of 40 mg/kg. At this dose level, .the extract showed a significant (