Knowledge of tuberculosis and self disclosure amongst patients accessing treatment in an urban Local Government Area, Lagos, south west Nigeria

Background: Disease-related stigma and knowledge of the disease by individual are believed to be associated with patients' willingness to seek and adhere to treatment. Increased morbidity and mortality of tuberculosis (TB) have been blamed on neglect of the human dimension of TB control. Assessing knowledge, self disclosure status and perceived stigma among TB patients would help to understand TB-related stigma as a social process and a better understanding of patients.Methods: A descriptive cross sectional study was carried out among newly diagnosed TB patients aged ≥18 years on treatment for at least four weeks. Consecutive enrollment was carried out in all the seven DOTS centers in Ikeja LGA.Patients were asked questions about TB knowledge, self- disclosure and level of perceived stigma. Knowledge scores were grouped as poor (1-11), fair (12-17) and good (18-22). A total of 309 patients were interviewed between January and September 2012.Results: Fifty-six percent of the patients were between 21 to 40 years with the male to female ratio of 1:1.13 while 45.3% and 51.5% had secondary school education and were married respectively. Thirty-two percent, 58% and 10% had poor, fair and good knowledge respectively. Majority (86%) of the patients have disclosed their status and treatment to family members with 39% disclosing to friends and associates. Regarding level of perceived stigma, 50% reported that having TB is an embarrassment to the family while 77% and 68% reported that TB patients should not share plates and sleep on the same bed with others respectively. Those with good knowledge and those that have retired from active service were more likely to selfdisclose to family members than others (p<0.05).Conclusion: Although perceived stigma and poor knowledge of TB was common among patients, most still disclosed status to family members. Health education of new patients on TB should be intensified.Keywords: TB, knowledge, selfdisclosure, stigm

Satisfaction among patients attending oncology clinic in a tertiary hospital in South West, Nigeria

Objective: This study determined patients' satisfaction with health care received at the oncology clinic in a tertiary hospital in Lagos, South West of Nigeria.Methods: A descriptive cross-sectional study was carried out among patients attending the oncology clinic in Lagos State University Teaching Hospital, Ikeja, Lagos. A total of 143 patients were recruited using a systematic random sampling and interviewer administered questionnaire was used to collect data. Analysis was done using Statistical Package for Social Sciences (SPSS version 20). Test of significance was performed using a 95% confidence interval and the level of significant set at p = 0.05.Results: More than half 123 (86.1%) reported that they got the kind of service they wanted, 125 (87.5%) reported almost all their needs had been met. Majority (92.3%) of the respondents were satisfied with the level of care received while 2.8% were indifferent and 7 (5%) were dissatisfied. The level of satisfaction was statistically significantly associated with age, marital status, level of education and average monthly income (p<0.05).Conclusion: Majority of patients were satisfied with the health care services at the oncology clinic. Regular satisfaction survey is recommendedKeywords: Patient satisfaction, oncology, tertiary hospita

Effect of health workers sensitization on satisfaction with immunization services among mothers of under fives in Ilorin, North Central Nigeria

Objective: Patients' satisfaction is a useful measure of the quality of service. An expression of satisfaction or dissatisfaction is also the patients' judgment on the quality of service in all its aspects. This study examined the effect of health workers sensitization on mothers' satisfaction with immunization service provided in health care facilities in a state in North Central Nigeria.Methods: This is a quasi-experimental study involving sensitization of health workers on quality health service provision at the study site, Alanamu Health Centre, Ilorin. The control group was at Okelele Health Centre, Ilorin. One hundred and fifty mothers were recruited from each of the facilities and the total population of mothers bringing their children (0-14 weeks old) for immunization was recruited consecutively for the study.Results: Less than 80% of respondents in the study group and the control group (73.3% and 77.3% respectively) were satisfied with the waiting time at the pre-intervention stage. At post-intervention, there was a significant increase in the proportion of mothers in the study group that were satisfied with the waiting time, seat provision and information received on immunization (p<0.05) while there were no significant changes in satisfaction among mothers in the control group regarding these measures (p>0.05). Age and level of education had significant influence on mothers' satisfaction (p<0.05).Conclusion: Mothers became more satisfied with various aspects of immunization service received after sensitization of health workers on quality health service. Sensitization of health workers towards quality health service may be necessary to generate options in service provision and improve client satisfaction.Keywords: Clients'Satisfaction, Immunization Services, Health Workers Sensitization, Nigeri

Structure of Primary Health Care: Lessons from a Rural Area in South-West Nigeria

Introduction and Objective Primary health care (PHC) is the basic strategy towards national health development in Nigeria, and provision of its services has been devolved to the local government. However, the PHC system in Nigeria has been hampered by several factors which have produced a negative effect on quality. It is assumed that given the proper structure, quality medical care will follow. Hence this study seeks to assess the structure of PHC in a rural area of Lagos state, southwest Nigeria. Methodology The study was carried out in Ikosi-Ejinrin local council development area (LCDA) of Lagos state, which had 9 primary health care facilities catering for a population of about 100,000 people, using a descriptive cross-sectional study design. Data was collected from health facilities and health workers using a health facility checklist and a structured questionnaire for the health workers. Results Most facilities (77.8%) had inadequate water and power supply, as well as inadequate sanitary toilet facilities. In addition 44.4% lacked basic equipment and none had a maintenance plan. Ambulance service was available in only 11.1% of the facilities. Only 33% of the facilities could be accessed easily by public transportation. Stewardship was unsatisfactory as no facility had a regular work schedule for its workers, none had a copy of the Essential Drugs List, and only 22.2% of the facilities enjoyed community participation in planning and management. There were only 19 health care workers for the LCDA. There was neither a medical doctor nor community health officer, and the workers comprised nurses/midwives (57.9%), senior and junior community health extension workers (CHEWs)-21.1% and 15.8% respectively, and pharmacy technician (5.2%). None of the workers had gone on any in-service training within the previous two years. No health care workers knew anything about the budget for the health facilities. None of the facilities had a functional 2-way referral system in place. Only 22.2% had adequate size, layout, utilities and furnishings. Conclusion The structure of PHC Ikosi-Ejinrin LCDA, a rural area in south-west Nigeria, is inadequate. There is a need for increased political will, funding and intersectoral collaboration. Technical supervision, manpower management, community participation and 2-way referral system need to be improved upon. Keywords: Structure of primary health care, rural area, southwest Nigeria

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