The magnitude of abdominal adiposity and atherogenic dyslipidemia among geriatric Nigerians with arterial hypertension in a rural hospital in South.eastern Nigeria

Background: As the case detection rate of arterial hypertension increases daily in rural Nigeria, screening for its associated abdominal obesity and dyslipidemia is an important healthcare challenge. Of great concern in rural Nigeria is that most geriatric hypertensives with abdominal obesity and dyslipidemia are not routinely diagnosed and therefore do not receive appropriate management.Objective: This study was aimed at describing the magnitude (prevalence and pattern) of abdominal adiposity using waist circumference (WC) index and dyslipidemia among geriatric Nigerians with arterial hypertension in a rural hospital in South.eastern Nigeria.Materials and Methods: A descriptive hospital.based study was carried out from June 2008 to June 2011 on 122 consecutive geriatric patients with systemic hypertension who met the selection criteria at St. Vincent De Paul Hospital, Amurie.Omanze, a rural Mission General Hospital in Imo state. Abdominal obesity was defined as WC .102 cm and .88 cm for men and women, respectively. Dyslipidemia was defined using the third report of National Cholesterol Education Panel in adult (ATP III). The data collected included basic demographic variables, blood pressure, waist circumference, fasting lipid profile, and blood sugar.Results: The prevalence of abdominal obesity was 50.8% and was the most common pattern of abdominal adiposity. Fifty.four (44.3%) out of 122 patients had at least one dyslipidemia with the most frequent being low high.density lipoprotein cholesterol (HDL.C, 38.5%). There was statistically significant difference between male and female genderbased on abdominal adiposity (X2 = 5.406, P value = 0.04) while their mean lipid differentials were not statistically significant.Conclusion: This study has shown that abdominal adiposity and dyslipidemia exist among geriatric hypertensives in the study area with abdominal obesity being the most common abdominal adiposity and low HDL.C being the most frequent lipid abnormality. This study therefore urges the necessity to consider abdominal obesity and dyslipidemia ingeriatric hypertensives in rural Nigeria alongside the complex of other cardiovascular risk factors

Evaluation of patients' satisfaction with quality of care provided at the National Health Insurance Scheme clinic of a tertiary hospital in South-Eastern Nigeria

Background: The umpteenth threats to change of healthcare provider by dissatisfied patients on formal sector health insurance are well known and can be a proxy indicator for the need for quality improvement in service delivery.Objective: This study was aimed at evaluating patientsf satisfaction with quality of care provided at the National Health Insurance Scheme (NHIS) clinic of a tertiary hospital in South.Eastern Nigeria.Materials and Methods: This was a descriptive study carried out on 400 NHIS patients from April 2011 to October 2011 at the general outpatient department of Federal Medical Centre, Umuahia. Patients were selected by simple random sampling using every second NHIS patient that registered to see the clinicians and who met the selection criteria. Data were collected using pretested, structured interviewer.administered questionnaire. Each satisfaction item was scored in a five.point Likert scale ordinal response, which was converted to percentage scale response. Satisfaction wasmeasured from the following domains: accessibility, patient waiting time, patient.provider communication, patient. provider relationship, hospital bureaucracy, and hospital environment. Operationally, patients who scored 50% and above in the assessed domain were considered satisfied while those who scored less than 50% were dissatisfied.Results: The overall satisfaction score of the respondents was 66.8%. Specifically, the respondents expressed satisfaction with patient.provider relationship (81.5%), patient.provider communication (79.9%), accessibility (74.2%), and hospital environment (68.2%) and dissatisfaction with hospital bureaucracy (48.8%) and patient waiting time (48.3%).Conclusion: This study has shown that the overall patients satisfaction with the services provided was very good with patient.provider relationship rated highest and patient waiting time the lowest. There is need to improve on the current level of patients satisfaction while effort should be made to address the identified domains of dissatisfaction

The use of plants in the traditional management of diabetes in Nigeria: Pharmacological and toxicological considerations

Ethnopharmacological relevance: The prevalence of diabetes is on a steady increase worldwide and it is now identified as one of the main threats to human health in the 21st century. In Nigeria, the use of herbal medicine alone or alongside prescription drugs for its management is quite common. We hereby carry out a review of medicinal plants traditionally used for diabetes management in Nigeria. Based on the available evidence on the species׳ pharmacology and safety, we highlight ways in which their therapeutic potential can be properly harnessed for possible integration into the country׳s healthcare system. Materials and methods: Ethnobotanical information was obtained from a literature search of electronic databases such as Google Scholar, Pubmed and Scopus up to 2013 for publications on medicinal plants used in diabetes management, in which the place of use and/or sample collection was identified as Nigeria. ‘Diabetes’ and ‘Nigeria’ were used as keywords for the primary searches; and then ‘Plant name – accepted or synonyms’, ‘Constituents’, ‘Drug interaction’ and/or ‘Toxicity’ for the secondary searches. Results: The hypoglycemic effect of over a hundred out of the 115 plants reviewed in this paper is backed by preclinical experimental evidence, either in vivo or in vitro. One-third of the plants have been studied for their mechanism of action, while isolation of the bioactive constituent(s) has been accomplished for twenty three plants. Some plants showed specific organ toxicity, mostly nephrotoxic or hepatotoxic, with direct effects on the levels of some liver function enzymes. Twenty eight plants have been identified as in vitro modulators of P-glycoprotein and/or one or more of the cytochrome P450 enzymes, while eleven plants altered the levels of phase 2 metabolic enzymes, chiefly glutathione, with the potential to alter the pharmacokinetics of co-administered drugs. Conclusion: This review, therefore, provides a useful resource to enable a thorough assessment of the profile of plants used in diabetes management so as to ensure a more rational use. By anticipating potential toxicities or possible herb–drug interactions, significant risks which would otherwise represent a burden on the country׳s healthcare system can be avoided

Spinal injuries admitted at the Federal Medical Centre, Umuahia over a 10-year period

Background: Spinal injury can have devastating effect on an individual from a physical, psychological and socio-economic point of view. It is a calamity in human life and there is a need to reduce the disability that could arise from it.Aim: To document the experience with spinal injuries at Umuahia.Methods: A  retrospective study of spinal injury (traumatic and non-traumatic)patients admitted into the wards of Federal Medical Centre Umuahia from 1st July 1996 to 30th July   2005, utilizing data from the patients case notes, casualty  and ward registers. Extracted data was analyzed using descriptive statisticsResults: During the period under review, 49 patients met the inclusion criteria. Their ages ranged from 12 to 85 years and there were 40 males and 9 females. There were more traumatic (85.7%) than non-traumatic (14.3%) injuries. The most  common traumatic injuries were motor vehicle accidents and falls from height, while the non-traumatic causes were metastases  from prostate cancer, Pott’s disease of the spine and disc prolapse. No neurological   deficit were noticed in 22.4% but 38.8% had paraplegia and 20.4% had quadriplegia. The most frequently affected vertebrae  were the cervical  and thoracic vertebrae. The treatment was mostly conservative . The most frequent complication were bowel dysfunction, urinary bladder dysfunction , urinary tract infection and pressure ulcers. Ten (20.4%) walked without support, 9(18.4%) discharged against medical advice and 4(8.2%) were discharged on wheel chair. Twenty-two (44.9%) were referred and there were 4 (8.2%) mortalities.Conclusion: There were more traumatic than non-traumatic injuries. The most common traumatic cause was motor vehicle accidents, while the most common non-traumatic cause was metastases from prostate cancer. There is a need to improve the level of care given to these patients. Keywords: Spinal injuries, Traumatic, Non-traumatic, Admission, Umuahi

Orthopaedic infuries in the elderly: Federal Medical Center, Umuahia experience.

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Blood pressure control among geriatric Nigerians with essential hypertension in a rural hospital in South- Eastern Nigeria

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Vaginal misoprostol for induction of labour in women with intrauterine fetal death at Aba, South-Eastern Nigeria

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Satisfaction with quality of care: a comparative study of National Health Insurance Scheme and non-National Health Insurance Scheme patients of a tertiary hospital in South-Eastern Nigeria

Background: The current trend towards consumer satisfaction driven healthcare services have been viewed as the compass for assessing quality of care in hospitals.  Aim: To compare satisfaction with quality of care received by national health insurance scheme (NHIS) and non-national health insurance scheme (non-NHIS) patients of a tertiary hospital in South- Eastern Nigeria.Methods: A comparative cross sectional study carried out on 400 NHIS and 400 non-NHIS patients from April 2011 to October 2011 at the Department of Family Medicine of Federal Medical Centre, Umuahia.  Adult patients seen within the study period who met the inclusion criteria were selected by systematic sampling using every second patient that registered to see the clinicians.  Data were collected using pretested, structured interviewer-administered questionnaire. Each satisfaction item was scored on a five points Likert scale ordinal response which was converted to percentages.Results: The overall average satisfaction score of the NHIS respondents was significantly higher than that for non-NHIS (66.8% vs 62.0%)(p=0.04). The NHIS respondents' satisfaction with patient-provider relationship (81.5% vs 78.0%) (p=0.062), patient-provider communication(79.9% vs 76.0%)(p=0.070) and accessibility(74.2% vs 72.8%)(p=0.072) were higher than that of non-NHIS patient. These relative differences were not statistically significant.  NHIS patients' satisfaction with waiting time (48.3% vs 48.0%)(p=0.224) and hospital bureaucracy (48.8% vs 47.0%)(p=0.213) were higher than that of non-NHIS patients. This difference was also not statistically significant. Conclusion: Overall NHIS respondents' satisfaction with the services provided was significantly higher than non-NHIS patients. There is need to improve on the current level of satisfaction in addition to addressing the identified domains of dissatisfaction with quality of care.Keywords: Comparative satisfaction, NHIS, Non-NHIS, Patients, Nigeria, Tertiary hospita

Prevalence of hepatitis-B surface antigen among blood donors and human immunodeficiency virus-infected patients in Jos, Nigeria

Information is very scarce on the prevalence of hepatitis-B virus (HBV) infection among blood donors and patients with human immunodeficiency virus (HIV) infection in Nigeria. Hepatitis-B surface antigen (HBsAg) ELISA was used to determined the prevalence of HBsAg among 175 blood donors (aged 20-40 years) and 490 HIV-infected patients (aged 17-60 years) in Jos, Nigeria. Twenty-five (14.3%) of the blood donors and 127 (25.9%) of the HIV-infected individuals were HBsAg seropositive, indicating a higher HBV infection among HIV-infected persons than among healthy blood donors. A slightly higher HBsAg seroprevalence was recorded in the males (14.6%) than females (12.9%) of the blood donors. Among the HIV-infected patients, the males had considerably higher HBsAg seroprevalence than the females (31.8 vs 22.1%) with the highest prevalence of HBsAg occurring in the 51-60 years age group (44%), followed by those of 31-40 years (28.2%). Results confirmed the high endemicity of HBV infection in Jos, Nigeria and the significantly greater prevalence of HBV infection among HIV -infected patients than among blood donors