Physicians and AIDS care: does knowledge influence their attitude and comfort in rendering care?

Adequate knowledge, positive attitude, and feeling of comfort are important factors in providing compassionate care to patients. The purpose of this study was to assess physicians' knowledge, attitude and global comfort in caring for patients with AIDS (PWA), to determine the sociodemographic variables that could influence physicians' attitude and global comfort, and to identify any relationship between their knowledge, attitude and comfort. Consultants and residents (N=211) in two Nigerian teaching hospitals were surveyed using a two-part questionnaire. Part I elicited sociodemographic and previous AIDS encounter information, and Part II assessed knowledge, attitude and global comfort with AIDS patients care. Nigerian physicians showed satisfactory knowledge, but they harbored negative attitude and low level of comfort in caring for PWA. Previous AIDS care experience, age and being a consultant or a senior resident influenced attitude, while male gender and knowing someone with AIDS influenced global comfort. Knowledge is weakly but positively associated with attitude, while attitude is modestly associated with comfort. The study reinforced the need for an ongoing education focused on experiential learning, and professional socialization in order to influence physicians' attitude and enhance their feeling of comfort when caring for PWA. African Journal of Health Sciences Vol. 14 (1-2) 2007: pp. 37-4

Prevalence of Chronic Kidney Disease in a Nigerian Family Practice Population

Background: Chronic kidney disease (CKD) is a global public health problem, with a greater burden and prohibitive cost of care particularly indeveloping countries. This study determined the prevalence of chronic kidney disease and identified its associated risk factors in patients attending the Family Practice Clinic, Wesley Guild Hospital, Ilesa, Nigeria.Method: Consecutive newly-registered patients who attended the Family Practice Clinic of Wesley Guild Hospital, Ilesa from August 2005 to January2006 were recruited and studied. Relevant data were collected by using an interviewer-administered questionnaire, and determining the spot urinaryACR (albumin-creatinine ratio) of the subjects by using Microalbustix™ reagent strips and using their serum creatinine concentration. The glomerular filtration rate (GFR) of each subject was estimated using the Modification of Diet in Renal Disease (MDRD) formula. A repeat urine test was done three months after the initial screening to identify subjects with persistent microalbuminuria.Results: The age of the study subjects ranged from 20 to 74 years, with a mean age of 50.52 + 13.03 years. There were 68 males and 182 females in the sample population, showing a male to female ratio of 1:2.7. One hundred and thirteen of the 250 subjects (45.2%) were found to have pathologic albuminuria at the initial screening, while 31 (12.4%) had persistent albuminuria three months later. Also, 51 subjects (20.4%) had estimated low GFR at the initial screening and 26 (10.4%) had persistent low GFR three months later. Significant risk factors for CKD in the study subjects were increasing age, elevated blood pressure, history of diabetes mellitus (DM), habitual intake of analgesics and herbs, and an abnormal waist to hip ratio (p < 0.05). The association between persistent abnormal ACR and low GFR did not reach statistical significance (p = 0.053). Habitual analgesic intake (p = 0.002) and age group (p = 0.0027) were true predictors of CKD among the study subjects.Conclusions: The prevalence of CKD in the study population was high and its association with modifiable risk factors was demonstrated. Familyphysicians have a unique opportunity to identify and address these factors in their patients. Routine screening for CKD in family practice clinics isindicated to reduce the burden of renal disease in the population

Antisickling agent in an extract of unripe pawpaw (Carica papaya): Is it real?

Investigations into antisickling and reversal of sickling activities of an aqueous extract of unripe pawpaw (Carica papaya) were carried out on blood from sickle cell patients (Haemoglobin SS, HbSS) using 2% sodium metabisulphite in a sickling test. The minimum concentration of the extract that achieved maximum antisickling in vitro and the fraction of the extract where the antisickling agent resides were determined. Our findings confirmed both antisickling and reversal of sickling activities ofthe extract. It was established that 1.0 g of unripe pawpaw in 1.0 ml of physiological saline was the minimum concentration that achieved maximum antisickling. Solvent partitioning of the extract withethyl acetate and butanol revealed that the antisickling agent in the extract of unripe pawpaw resides in the ethyl acetate fraction as this fraction prevented sickling of Hb SS red cells and reversed sickled HbSS red cells in 2% sodium metabisulphite whereas the butanol and aqueous fractions had none of these properties. We concluded that extract of unripe pawpaw really has antisickling agent and that thisantisickling agent lies in the ethyl acetate fraction of the extract

Pattern of depression among patients in a Nigerian family practice population

Background: This study determines the pattern of depression among patients attending the Family Practice Clinic at Wesley Guild Hospital, Ilesa, Nigeria. Socio-demographic and clinical correlates associated with depression were identified. Methods: Two hundred and fifty (250) newly registered patients who attended the clinic between June and September 2005 were selected by the systematic random sampling method and studied. Relevant data were collected using a pre-tested interviewer- administered questionnaire that incorporated Zung\'s Depression Scale. Results: The age of the study subjects ranged from 16 to 84 years, with a mean age of 49.66 + 14.95 years. One hundred and forty-nine of the 250 subjects (59.6%) were found to have one form of depression or the other. Of these, one hundred and seven (42.8%) had mild depression, forty (16.0%) had moderate depression and only two (0.8%) had severe depression. Depression was found to be commoner in the age groups from 45 years and above, and there was a significant association between age and depression. There were 74 males and 176 females in the sample population, showing a male to female ratio of 1:2.4. Out of 149 depressed subjects, one hundred and four females (69.8%) had depression, while depression was present in 45 males (30.2%). Forty-seven (87.0%) of 54 subjects with no formal education had depression, while depression was found in 102 (52.0%) of the 196 educated subjects. Low educational status was significantly associated with depression in this study. Only two (0.8%) of the 250 subjects gave a positive family history of psychiatric illness, and these two subjects had mild to moderate depression. The proportion of depressed subjects who lived below the poverty level was significantly greater than that of non-depressed subjects. Substance use was also significantly more common among depressed subjects than the non-depressed group. Conclusion: The proportion of patients with depressive symptoms in family practice clinics is high, and it is highly correlated with socio-demographic factors and low socioeconomic status. Family physicians are hereby enjoined to pay greater attention to patients with these factors, as they are at increased risk of depression. In order to reduce the high proportion of depressive symptoms and its adverse impacts on patients seen in family practice clinics and in the community as a whole, there is a need for effective implementation of poverty-alleviation programmes and universal basic education. South African Family Practice Vol. 50 (2) 2008: pp. 63-63

Determinants of patient satisfaction with physician interaction: a cross-sectional survey at the Obafemi Awolowo University Health Centre, Ile-Ife, Nigeria

Background: Patient satisfaction influences the outcomes of the physician-patient encounter. Patient satisfaction has become a significant health care outcome and a useful indicator of the quality of care. The aim of the study was to assess the level of satisfaction among Obafemi Awolowo University Health Centre attendees in relation to physician-patient interaction and ascertain the relationship between the different aspects of physician-patient interaction, patient satisfaction and adherence intent.Methods: Demographic information and information on patients’ feelings about their doctors was collected from 300 consenting patients in a cross-sectional survey, using an adapted Medical Interview Satisfaction Scale self-administered questionnaire. Data were analysed with SPSS version 11. Logistic regression was conducted to identify the factors predicting patient satisfaction and adherence intent.Results: Of the 300 patients studied, 63.3% were generally satisfied with their physician-patient interaction. Nineteen per cent of patients were uncertain of their level of satisfaction. Patient satisfaction was positively associated with adherence intent. Patient confidence in the doctor and good communication skills and information provision on the part of the doctor predicted patient satisfaction, while patient confidence in the doctor and information provision by the doctor predicted adherence intent.Conclusions: A fifth of the study subjects were dissatisfied with their doctor-patient relationship. This study suggests the need for primary care physicians to be aware of the important place of interpersonal skills development in the application of medical knowledge and expertise in the provision of health care.Keywords: patient satisfaction; doctor-patient interaction; adherence intent; patient outcome

Biochemical alteration in Nigerian children with acute falciparum malaria

This study was undertaken to establish data on the effect of acute falciparum malaria on plasma levels some biochemical parameters in the pathology of malaria in Nigeria children. We estimated the levels ofNa+, K+, HCO3, Ca++ , inorganic PO4 =, bilirubin, total protein, albumin, urea, creatinine and glucose in the plasma of 250 parasitaemic and 150 non-parasitaemic Nigerian children. Inorganic PO4 =, urea, creatinine and bilirubin levels were significantly elevated in the acute falciparum malarious children than in the non-parasitaemic controls. Acute falciparum malaria resulted in significant reduction of HCO3 -, total protein, albumin and glucose levels in the malarious children. There was no significant difference in the mean values of the biochemical parameters between malarious children with relative parasite count of 1-10 asexual form of parasite in 100 high power field (hpf) of thick blood film (+) and those with 11-100 asexual form of parasite in 100 hpf of thick blood film(++)

Biological sample donation and informed consent for neurobiobanking: Evidence from a community survey in Ghana and Nigeria

Copyright: \ua9 2022 Singh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction Genomic research and neurobiobanking are expanding globally. Empirical evidence on the level of awareness and willingness to donate/share biological samples towards the expansion of neurobiobanking in sub-Saharan Africa is lacking. Aims To ascertain the awareness, perspectives and predictors regarding biological sample donation, sharing and informed consent preferences among community members in Ghana and Nigeria. Methods A questionnaire cross-sectional survey was conducted among randomly selected community members from seven communities in Ghana and Nigeria. Results Of the 1015 respondents with mean age 39.3 years (SD 19.5), about a third had heard of blood donation (37.2%, M: 42.4%, F: 32.0%, p = 0.001) and a quarter were aware of blood sample storage for research (24.5%; M: 29.7%, F: 19.4%, p = 0.151). Two out of ten were willing to donate brain after death (18.8%, M: 22.6%, F: 15.0%, p&lt;0.001). Main reasons for unwillingness to donate brain were; to go back to God complete (46.6%) and lack of knowledge related to brain donation (32.7%). Only a third of the participants were aware of informed consent (31.7%; M: 35.9%, F: 27.5%, p&lt;0.001). Predictors of positive attitude towards biobanking and informed consent were being married, tertiary level education, student status, and belonging to select ethnic groups. Conclusion There is a greater need for research attention in the area of brain banking and informed consent. Improved context-sensitive public education on neurobiobanking and informed consent, in line with the sociocultural diversities, is recommended within the African sub region

Abdominal ultrasonography in HIV/AIDS patients in southwestern Nigeria

<p>Abstract</p> <p>Background</p> <p>Though the major target of the HIV-virus is the immune system, the frequency of abdominal disorders in HIV/AIDS patients has been reported to be second only to pulmonary disease. These abdominal manifestations may be on the increase as the use of antiretroviral therapy has increased life expectancy and improved quality of life. Ultrasonography is an easy to perform, non invasive, inexpensive and safe imaging technique that is invaluable in Africa where AIDS is most prevalent and where sophisticated diagnostic tools are not readily available. Purpose: To describe the findings and evaluate the clinical utility of abdominal ultrasonography in HIV/AIDS patients in Ibadan, Nigeria</p> <p>Methods</p> <p>A Prospective evaluation of the abdominal ultrasonography of 391 HIV-positive patients as well as 391 age and sex-matched HIV-negative patients were carried out at the University College Hospital, Ibadan.</p> <p>Results</p> <p>Of the 391 cases studied, 260 (66.5%) were females; the mean age was 38.02 years, (range 15–66 years). The disease was most prevalent in the 4th decade with an incidence of 40.4%. Compared with the HIV-negative individuals, the HIV+ group of patients had a significantly higher proportion of splenomegaly (13.5% vs. 7.7%; p < 0.01), lymphadenopathy (2.0% vs. 1.3%; p < 0.70), and renal abnormalities (8.4% vs. 3.8%; p < 0.02). There were no differences in hepatic and pancreatic abnormalities between the HIV+ and HIV- groups. There were significantly fewer gallstones in the HIV+ group (1.4% vs. 5.1%; p < 0.01).</p> <p>Conclusion</p> <p>AIDS is a multi-systemic disease and its demographic and clinical pattern remains the same globally. Ultrasonography is optimally suited for its clinical management especially in Africa. Its accuracy and sensitivity may be much improved with clinico-pathologic correlation which may not be readily available in developing countries; further studies may provide this much needed diagnostic algorithms.</p

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

SummaryBackground The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation