Perceptions about family-centred care among adult patients with chronic diseases at a general out-patient clinic in Nigeria

Thesis (MFamMed)--Stellenbosch University, 2017.The published article for this Master’s is available at http://hdl.handle.net/10019.1/106435ENGLISH SUMMARY : Background: Few studies in Africa have described patients’ preferences for family involvement in their care. Such perceptions when elicited, can provide the patient-oriented evidence needed for implementation of family-centred care (FCC) in an African context. The aim of this study was to explore perceptions of FCC among patients with chronic diseases. Specific objectives where therefore to elicit (1) patients’ perceptions of the meaning of FCC, explore (2) current involvement of family members in patient care (3), value of FCC from the patient’s perspective and (4) patients’ preferences in the delivery of FCC. Methods: A mixed-methods phenomological study design incorporating structured and semi-structured, individual in-depth interviews for 21 adult patients with chronic diseases was used. It was carried out at the general out-patient clinic of the Jos University Teaching Hospital, Jos, Plateau state, Nigeria. Results: Patients described FCC using various levels of family engagement with their care including, the doctor inquiring about history of similar disease in the family, information sharing with family members and fostering of family ties/relationships. These levels were also seen in the description of current family involvement in their care, including inquiring about their health, going with them to the clinic, offering material/social support and health advice. Similarly, patients considered the value of FCC based on how it meets information needs of the family, influences individual health behaviour and addresses family dynamics. The patients showed a broad range of preferences from minimal to maximum engagement of family in their care. This preference was influenced by the need for confidentiality, perception of the illness experience and whose opinion they valued most. Conclusion: Not all patients showed a preference for maximum family engagement in their care. Hence, there exists a need to be sensitive to the patient’s preferences during consultations. However, depending on perceived benefit, the family doctor may need to educate and negotiate with the patient, the extent to which family members can be involved in their care.AFRIKAANSE OPSOMMING : Geen opsomming beskikbaar

Methanolic extract of Nauclea diderrichii (stem-bark) show anti-microbial, anti-oxidant and anti-inflammatory bioactivities

The aqueous stem-bark extract of the tropical plant Nauclea diderrichii is used in ethnomedicine to manage symptoms of rheumatism through minimally examined mechanisms. The objective of the study is to examine the scientific bases for the ethnomedicinal use of the plant for the management of rheumatism. As part of this effort to explain its ethnomedicinal efficacy, this study compared and contrasted the anti-microbial, anti-oxidant and anti-inflammatory activities of the methanolic extract with that of the diethylether extract. Broth dilution assay, DPPH radical scavenging assay and carrageenan-induced foot swelling of 7-day old chicks were utilized for the experimental assessment of the bioactivities of Nauclea diderrichii. Polar methanolic extract exhibited a higher antioxidant status in vitro as estimated quantitative differences in total phenolic content, in total antioxidant capacity and in DPPH and H2O2 radical scavenging converged to show the methanolic extract as a more potent anti-oxidant. The methanolic extract also possess better in vivo anti-inflammatory activity as demonstrated by the 1.5-fold lower ED50 relative to that of the diethylether. The methanolic extract demonstrated better broad-spectrum anti-microbial activity against a panel of six clinical isolates of bacterial and fungi pathogens in vitro. The relative strength of the bioactivities of the methanolic extract derives from a higher slew of phytochemical content that is a 3-fold difference larger. The results of this study support the beneficial effect of Nauclea diderrichii in its continuing ethnomedicinal use to target rheumatism chemotherapeutically

Perceptions about family-centred care among adult patients with chronic diseases at a general outpatient clinic in Nigeria

Background: Few studies in Africa have described patients’ perceptions about family-centred care (FCC). Aim: The aim of this study was to explore perceptions of FCC among patients with chronic diseases. Setting: The study was conducted at a general outpatient clinic (GOPC) in Jos, north-central Nigeria. Methods: We used a mixed-methods phenomenological study design and conducted structured and semi-structured interviews with 21 adult patients with chronic diseases at a general outpatient clinic in north-central Nigeria. Results: Patients described FCC using progressive levels of family engagement including the doctor inquiring about history of similar disease in the family, information sharing with family members and fostering of family ties. They described current family involvement in their care as either inquiring about their health, accompanying them to the clinic or offering material or social support and health advice. Also, patients considered the value of FCC based on how it meets information needs of the family, influences individual health behaviour and addresses family dynamics. Those who were literate and older than 50 years of age favoured FCC during history taking. Those who were literate, aged lesser than 50 years and had poor disease control showed preference for FCC during treatment decision-making. Conclusion: The acceptability of FCC is a complex synthesis of age, socio-economic status, literacy and disease outcomes. Patients older than 50 years, with good treatment outcomes, and those without formal education may need further education and counselling on this approach to care

Psychoactive substance use in a sample of community outreach participants; prevalence, correlates and ease of incorporating care

Background: The misuse of licit and illicit substances has continued to constitute a profound effect and harm across various societies. This study examined the nature of substance use, abuse and dependence in a community setting in Jos, Plateau State and the ease of carrying out screening, brief intervention and referral for substance use problems.Methods: Data for this study was gathered through a community-based medical outreach with a total of 1170 residence (M=36.97, SD=15.33), within the research area in participation. A cross-sectional research design was used to examine the prevalence and correlates of psychoactive substance consumption (excluding alcohol).Results: Analysis revealed that tobacco 51%, marijuana 22%, opioids 15%, sedatives 6%, and amphetamine 2%, were the current most significant substances used within the population. The ASSIST and MINI diagnostic criteria noted a significant rate of substance abuse and dependence (p<0.05) for tobacco, marijuana, amphetamine, inhalants, sedatives, hallucinogens, and opioid. Brief intervention based on the FRAMES techniques as employed in this study, was used in a total of 211 participants among whom 36 further received counseling for substance abuse and 60 were referred for specialized drug treatment therapy due to substance dependence. Gender, living environment, employment status and occupation were significant predictors of substance use across the participants. Specifically, male, participants who have stable accommodation, those with regular employment and students were found to be the group with the most significant rates of substance and substance use disorders.Conclusions: This study concludes among others, that the ASSIST, MINI and Brief Intervention were indeed effective for substance-related diagnosis in community-based medical programs and can be effectively incorporated into routine services with adequate planning, training and execution

Lifestyle, cardiovascular risk knowledge and patient counselling among selected sub-Saharan African family physicians and trainees. African journal of primary health care & family medicine

Background: Cardiovascular disease (CVD)-related deaths in sub-Saharan Africa (SSA) are on the rise, and primary care physicians could facilitate the reversal of this trend through treatment and prevention strategies. Aim: The aim of this study was to determine the relationship between physician lifestyle practices, CVD prevention knowledge and patient CVD counselling practices among family physicians (FPs) and family medicine (FM) trainees affiliated to FM colleges and organisations in SSA. Setting: FPs and FM trainees affiliated to FM colleges and organisations in Anglophone SSA. Methods: A web-based cross-sectional analytical study was conducted using validated, self-administered questionnaires. Following collation of responses, the relationship between the participants’ CVD prevention knowledge, lifestyle practices and CVD counselling rates was assessed. Results: Of the 174 participants (53% response rate), 83% were married, 51% were females and the mean age was 39.2 (standard deviation [SD] 7.6) years. Most of the participants responded accurately to the CVD prevention knowledge items, but few had accurate responses on prioritising care by 10-year risk. Most participants had less than optimal lifestyle practices except for smoking, vegetable or fruit ingestion and sleep habits. Most participants (65%) usually counselled patients on nutrition, but less frequently on weight management, exercise, smoking and alcohol. The region of practice and physicians with poor lifestyle were predictive of patient counselling rates. Conclusion: Training on patient counselling and self-awareness for CVD prevention may influence patient counselling practice. Promoting quality training on patient counselling among FPs as well as a healthy self-awareness for CVD prevention is thus needed. The complex relationship between physician lifestyle and patient counselling warrants further study

Meeting report: ‘How do I incorporate research into my family practice?’: Reflections on experiences of and solutions for young family doctors

Background: Family doctors (FDs) focus on biopsychosocial components of health during consultations. However, much of the evidence employed by these doctors is produced by researchers who are not routinely involved in family practice. Family doctors competent in both clinical practice and research are essential to addressing this gap. With the growing recognition of family medicine as the specialty of choice for many young doctors, there is a scarcity of literature that describes their experiences in combining research and daily family practice. Aim: Members from Young Doctor Movements (YDMs) under the auspices of the World Organisation of Family Doctors (WONCA) sought to address this knowledge gap by reflecting on their experiences towards becoming researchers. With the assistance of senior doctors, they explored solutions that can help young FDs incorporate research into their family practice. Methods: Following an online YDM meeting, a summary of the experiences of young FDs as well as strategies useful for incorporating research into their everyday practice as FDs was prepared. Result: Nine thematic areas were derived, including experiences and motivation towards regular research, culture and environment of practice, relevance and gains of research, teamwork and mentorship. Conclusion: Family practices can incorporate research by promoting a personal and organisational research culture, highlighting gains and relevance of making it part of the profession and fostering teamwork, supportive networks and mentorship while making it enjoyable

Predictors of late presentation for obstetric fistula repair in Abakaliki, South-East Nigeria

Late presentation is a challenge to reducing the backlog of obstetric fistulas. We aimed to identify characteristics of women presenting late for repair in order to improve patient recruitment. It was a cross-sectional comparative study. Data was collected from the women and the hospital notes using proforma and analysed using SPSS. Associations between categorical variables were determined using Chi-square. Predictors of late presentation were determined using logistic regression. A P-value of &lt;0.05 was statistically significant. The mean time of presentation was 42.3 months. Late presentation was significantly associated with age &gt;35 years, parity &lt; 3, not having a spouse, and trauma. On logistic regression, women aged 35 years and above were five times more likely to present late compared with younger ones (AOR= 5.192, 95%CI 1.839-14.660, P=0.002), while women with parity &gt;3 were five times less likely to present late compared with those &lt;3 (AOR= 0.208, 95%CI 0.073-0.587, P=0.003). In conclusion, most patients presented late. Although age, parity, having a spouse, and aetiology were associated with time of presentation, age &gt;35 years and parity &lt; 3 were the significant predictors of late presentation. Recruitment for early repair should be a priority area of the national policy for the elimination of obstetric fistula. &nbsp; La présentation tardive est un défi pour réduire l'arriéré des fistules obstétricales. Nous avons cherché à identifier caractéristiques des femmes se présentant tardivement pour réparation afin d'améliorer le recrutement des patientes. Il s'agissait d'une étude comparative transversale. Les données ont été recueillies auprès des femmes et des notes d'hôpital à l'aide de formulaires proforma. et analysés à l'aide de SPSS. Les associations entre les variables catégorielles ont été déterminées à l'aide du Chi carré. Les prédicteurs de présentation tardive ont été déterminés à l'aide de la régression logistique. Une valeur p de &lt;0,05 était statistiquement significatif. Le délai moyen de présentation était de 42,3 mois. La présentation tardive était significativement associé à l'âge &gt; 35 ans, la parité &lt; 3, l'absence de conjoint et un traumatisme. En régression logistique, les femmes âgés de 35 ans et plus étaient cinq fois plus susceptibles de se présenter tardivement que les plus jeunes (AOR = 5,192, IC à 95 % 1,839-14,660, P=0,002), tandis que les femmes avec une parité &gt;3 étaient cinq fois moins susceptibles de présenter en retard par rapport à ceux &lt;3 (AOR = 0,208, IC à 95 % 0,073-0,587, P = 0,003). En conclusion, la plupart des patients présenté tardivement. Bien que l'âge, la parité, le fait d'avoir un conjoint et l'étiologie soient associés au temps de la présentation, l'âge &gt; 35 ans et la parité &lt; 3 étaient les prédicteurs significatifs de la présentation tardive. Recrutement la réparation précoce devrait être un domaine prioritaire de la politique nationale d'élimination de la fistule obstétricale

Exploring gaps, strategies and solutions for primary care research mentorship in the African context: A workshop report

McGuire CM, Yakubu K, Ayisi-Boateng NK, et al. Exploring gaps, strategies and solutions for primary care research mentorship in the African context: A workshop report. Afr J Prm Health Care Fam Med. 2020;12(1), a2320. https://doi.org/10.4102/phcfm.v12i1.2320The original publication is available at http://www.phcfm.orgBackground: Primary care needs research to generate evidence relevant to community needs; however, there is a lack of research engagement among primary care physicians, especially in sub-Saharan Africa. Improved research mentorship for family physicians (FPs) can help address prevailing knowledge and practice gaps in primary care research. Workshop process: During the 6th annual Africa Regional Conference of the World Organization of Family Doctors (WONCA), we conducted three workshops on research mentorship for African FPs. Two workshops (one online and one onsite at the pre-conference) were geared towards the young doctors’ movement of WONCA Africa. The third was onsite during the main conference. Following a brief presentation on the concept of research mentorship and known gaps, participants broke into small groups and discussed additional gaps, solutions and anticipated readiness for implementing these solutions. We used content analysis to summarise key concepts and had participants to review the findings. Workshop findings: Identified gaps related to mentees’ difficulty initiating and maintaining mentorship relationships and an overall shortage of capable and willing mentors. Organizational solutions focused on capacity building and creating a culture of mentorship. Interpersonal solutions focused on reducing the power distance and increasing reflectivity and feedback. Increasing the use of research networks and both peer and online mentorship were advocated. Barriers to readiness included resource constraints and competing priorities. Conclusion: A multi-level approach is needed to address the gaps in research mentorship for African FPs. Identified solutions hold potential for supporting the research engagement needed to improve the population health across Africa. Keywords: research; mentorship; primary care; general practice; family medicine; sub- Saharan Africa; workshop report

Use of proton pump inhibitors to treat persistent throat symptoms: Multicentre, double blind, randomised, placebo controlled trial

Objective. To assess the use of proton pump inhibitors (PPIs) to treat persistent throat symptoms. Design. Pragmatic, double blind, placebo controlled, randomised trial. Setting. Eight ear, nose, and throat outpatient clinics, United Kingdom. Participants. 346 patients aged 18 years or older with persistent throat symptoms who were randomised according to recruiting centre and baseline severity of symptoms (mild or severe): 172 to lansoprazole and 174 to placebo. Intervention. Random blinded allocation (1:1) to either 30 mg lansoprazole twice daily or matched placebo twice daily for 16 weeks. Main outcome measures. Primary outcome was symptomatic response at 16 weeks measured using the total reflux symptom index (RSI) score. Secondary outcomes included symptom response at 12 months, quality of life, and throat appearances. Results. Of 1427 patients initially screened for eligibility, 346 were recruited. The mean age of the study sample was 52.2 (SD 13.7) years, 196 (57%) were women, and 162 (47%) had severe symptoms at presentation; these characteristics were balanced across treatment arms. The primary analysis was performed on 220 patients who completed the primary outcome measure within a window of 14-20 weeks. Mean RSI scores were similar between treatment arms at baseline: lansoprazole 22.0 (95% confidence interval 20.4 to 23.6) and placebo 21.7 (20.5 to 23.0). Improvements (reduction in RSI score) were observed in both groups—score at 16 weeks: lansoprazole 17.4 (15.5 to19.4) and placebo 15.6 (13.8 to 17.3). No statistically significant difference was found between the treatment arms: estimated difference 1.9 points (95% confidence interval −0.3 to 4.2 points; P=0.096) adjusted for site and baseline symptom severity. Lansoprazole showed no benefits over placebo for any secondary outcome measure, including RSI scores at 12 months: lansoprazole 16.0 (13.6 to 18.4) and placebo 13.6 (11.7 to 15.5): estimated difference 2.4 points (−0.6 to 5.4 points). Conclusions. No evidence was found of benefit from PPI treatment in patients with persistent throat symptoms. RSI scores were similar between the lansoprazole and placebo groups after 16 weeks of treatment and at the 12 month follow-up

Lifestyle, cardiovascular risk knowledge and patient counselling among selected sub-Saharan African family physicians and trainees

Background: Cardiovascular disease (CVD)-related deaths in sub-Saharan Africa (SSA) are on the rise, and primary care physicians could facilitate the reversal of this trend through treatment and prevention strategies. Aim: The aim of this study was to determine the relationship between physician lifestyle practices, CVD prevention knowledge and patient CVD counselling practices among family physicians (FPs) and family medicine (FM) trainees affiliated to FM colleges and organisations in SSA. Setting: FPs and FM trainees affiliated to FM colleges and organisations in Anglophone SSA. Methods: A web-based cross-sectional analytical study was conducted using validated, self-administered questionnaires. Following collation of responses, the relationship between the participants’ CVD prevention knowledge, lifestyle practices and CVD counselling rates was assessed. Results: Of the 174 participants (53% response rate), 83% were married, 51% were females and the mean age was 39.2 (standard deviation [SD] 7.6) years. Most of the participants responded accurately to the CVD prevention knowledge items, but few had accurate responses on prioritising care by 10-year risk. Most participants had less than optimal lifestyle practices except for smoking, vegetable or fruit ingestion and sleep habits. Most participants (65%) usually counselled patients on nutrition, but less frequently on weight management, exercise, smoking and alcohol. The region of practice and physicians with poor lifestyle were predictive of patient counselling rates. Conclusion: Training on patient counselling and self-awareness for CVD prevention may influence patient counselling practice. Promoting quality training on patient counselling among FPs as well as a healthy self-awareness for CVD prevention is thus needed. The complex relationship between physician lifestyle and patient counselling warrants further study