Self-reported medical care seeking behaviour of doctors in Nigeria

AbstractBackgroundThere is need for information on the medical care seeking behaviour of Nigerian doctors.PurposeThis work was therefore designed to study the medical care seeking behaviour of Nigerian doctors in Nigeria.MethodsIt was a cross-sectional survey among doctors in Nigeria.ResultsData from 522 doctors were included in the analysis. Majority of them (80.5%) had one form of illness or the other in the year preceding the survey. Only 35% of them reportedly consulted another doctor during their illness. Most of the consultations (61.2%) were informal in the form of over the phone (45.6%), Corridor (33.3%) and home visit (21.1%) and just 18.4% of the consultations occurred within 24h of onset of illness. A low 19.5% of them had a regular source of medical care. Screening for illnesses was generally below expectation. Just 6 out of the 436 (1.4%) male doctors had screened for prostate cancer while 39 out of 86 (45.3%) females had screened for cervical cancer. A significantly higher proportion of general practitioners (p=0.01) and doctors above 45 years of age (P=0.004) consulted informally. Higher proportion of general practitioners and resident doctors based their consultations on their familiarity with the doctors consulted (p=0.001) and privacy during consultation (p=0.001). Delay in consultation for more than 24h after onset of illness was more likely in those above below the age of 45 years (p=0.001).ConclusionThis study has shown that Nigerian doctors are often reluctant patients who frequently tend to delay medical care. The teaching of appropriate medical care seeking behaviour should be incorporated into medical curriculum in Nigeria

PATTERN AND EXPLANATORY FACTORS FOR MEDICATION ADHERENCE AMONG PATIENTS WITH HYPERTENSION, DIABETES MELLITUS AND THEIR COMORBIDITY IN A NORTH CENTRAL STATE OF NIGERIA

Introduction: Hypertension and diabetes are the two most common non-communicable diseases seen in outpatient clinics in Sub-Saharan Africa. Promoting medication adherence is a major clinical hurdle to be crossed in reducing the premature morbidity and mortality associated with these diseases. This study explored factors that predict medication adherence among hypertensive and diabetic patients in Ilorin, Nigeria. Methods: This cross-sectional study was carried out among hypertensive and diabetic patients in outpatient clinics of a teaching hospital in Ilorin, Nigeria. Data was collected from 1,203 patients using a validated Morisky 8-item medication adherence questionnaire. Multivariate ordinal logistic regression was used to model the medication adherence explanatory factors with SPSS version 22. Result: Less than half (43.3%) of the patients were highly adherent to their medication. The relative proportion for high adherence was 42.7%, 35.6% and 49.2% for hypertension, diabetes and both diseases respectively. The odds of medication adherence improving from either low to medium level or from medium to high level was explained by; age, symptoms count, absence of disease complication and absence of drug side effect among the patients. Blood pressure, gender and disease duration did not explain medication adherence among hypertensive and diabetic patients. Conclusion: It is concluded that the discomfort experienced due to the disease condition and the medication regimen are important explanatory factors for patient’s medication adherence in the study setting. This study recommends strategies to reduce multiple drug combinations and promote medication adherence counselling and education among patients

PREDICTIVE FACTORS OF MEDICATION ADHERENCE AMONG HYPERTENSIVE AND DIABETICS PATIENTS IN A NORTH CENTRAL STATE OF NIGERIA

Introduction: Hypertension and diabetes are the two most common non-communicable diseases seen in outpatient clinics in Sub-Saharan Africa. Promoting medication adherence is a major clinical hurdle to be crossed in reducing the premature morbidity and mortality associated with these diseases. This study explored factors that predict medication adherence among hypertensive and diabetic patients in Ilorin, Nigeria. Methods: This cross-sectional study was carried out among hypertensive and diabetic patients in outpatient clinics of a teaching hospital in Ilorin, Nigeria. Data was collected from 1,203 patients using a validated Morisky 8-item medication adherence questionnaire. Multivariate ordinal logistic regression was used to model the medication adherence explanatory factors with SPSS version 22. Result: Less than half (43.3%) of the patients were highly adherent to their medication. The relative proportion for high adherence was 42.7%, 35.6% and 49.2% for hypertension, diabetes and both diseases respectively. The odds of medication adherence improving from either low to medium level or from medium to high level was explained by; age, symptoms count, absence of disease complication and absence of drug side effect among the patients. Blood pressure, gender and disease duration did not explain medication adherence among hypertensive and diabetic patients. Conclusion: It is concluded that the discomfort experienced due to the disease condition and the medication regimen are important explanatory factors for patient’s medication adherence in the study setting. This study recommends strategies to reduce multiple drug combinations and promote medication adherence counselling and education among patients

Female sexual dysfunction in women of reproductive age group in Nigeria, West Africa

Introduction: Female Sexual Dysfunction (FSD) is a real physical, psychological, social, spiritual and cultural problem in Nigeria, yet greatly understudied. There is plethora of information about male sexual dysfunction but paucity of research on female dysfunction.Objectives: This study aims to assess the prevalence of FSD and correlates among women of reproductive age presenting at the General Outpatient Department of Kwara State Specialist Hospital.Method: This was a hospital based, cross sectional, descriptive study of three hundred female of reproductive age group. Blood pressure was measured. Classification of hypertension was made according to the JNC 7. BMI was calculated as (kg/m2).The Female Sexual Function Index (FSFI) was used to assess the major components of sexual function. Participant were considered to have difficulties in a particular domain if they demonstrated scores <4.28 on the desire domain, <5.08 on the arousal domain, <5.45 on the lubrication domain, <5.05 on the orgasm domain, <5.04 on the satisfaction domain and <5.51 on the pain domain. The data were analyzed using the epidemiological information (Epi-info) 2005 software package. The 2 by 2contingency tables were used to carry out Chi-square test and to find out the level of significance and values less than 0.05 were regarded as statistically significant.Result: Of the 300 female patients interviewed, 285 (95%) had sexual dysfunction while 15 (5%) did not. Types of sexual dysfunctional include, disorder of desire 273(91%), arousal 267(89%), lubrication 297(99%), orgasm 276(92%), satisfaction 258(86%) and pain 297(99%).Conclusion: The findings of the study suggest that female sexual dysfunction is a significant problem that affects a substantial number of women in this environment. The most common dysfunction amongst women was in the pain and lubrication domains. The commonest cause of sexual dysfunction was aging, closely followed by socio-demographic predicament.Keywords: Female Sexual Dysfunction, Reproductive Age Group, Nigeria, West Afric

Depression among people living with HIV/AIDS in Ilorin, Nigeria

Background: Depressive disorders are a significant public health problem. They are prevalent, disabling, and often chronic, with a high economic burden to the society. Although depression is common, determining its prevalence across studies and within different segments of the HIV population is not easy, given the variety of methodological issues that warrant consideration. This study estimates the prevalence of depressive disorders and its correlates.Objectives: The study sought to determine the prevalence of depression among adult HIV/AIDS respondents, attending HIV/AIDS clinic in the Kwara State specialist Hospital, Sobi, Ilorin, Nigeria.Methods: This was a hospital based, cross sectional, descriptive study of three hundred adult HIV/AIDS patients attending the HIV clinic of the Kwara State Specialist Hospital, Sobi, Ilorin from 1st of March to 3oth July, 2014. Informed consent was obtained from the respondents. The PHQ-9 was administered to the respondents to screen for depression. A pre-tested PHQ-9 questionnaire was used to collect data. Subjects who scored one and more were assessed clinically for depression. The severity of the depression was further classified as minimal, mild, moderate and severe. The three keys to social determinants of depression (SDS) were assessed and the association with depression sought.Results: One hundred and seventy (56.7%) satisfied the criteria for a depressive disorder using the PHQ-9 score. Depressive symptoms were strongly related to gender, below average year of schooling, poor economic status, low social cohesion and stressful life events.Conclusion: Clinicians should assess HIV-infected people for depression, to ensure early detection and treatment. Failure to recognize depression may endanger both the subjects and others in the community. This result calls for improved public health education and awareness to highlight the health impact of depressive symptoms among People Living with HIV/AIDS (PLWHA). Keywords: Prevalence; Depression; HIV/AIDS; People Living with HIV/AID

Anthropometric correlates of adolescents' physical activity pattern

Background: Regular physical activity has long been regarded as an important component of a healthy lifestyle. Recently, this impression has been reinforced by new scientific evidence, linking regular physical activity to a wide array of physical and mental benefits. The purpose of this study, with a focus on adolescents, is to serve as a contribution to the body of local literature which at present is scanty.Objectives: The study described the adolescents' physical activity and inactivity patterns in relation to their anthropometry as seen in a primary care clinic.Methods: The study was a hospital based cross-sectional survey of 500 adolescents aged 10 – 19 years, attending adolescent clinic of the Department of Family Medicine, University of Ilorin Teaching Hospital (UITH), Ilorin, Kwara State of Nigeria. A pre-tested questionnaire on physical activities was administered. In addition, anthropometric measurements of respondents were taken.Results: The proportion of respondents who participated in moderate to vigorous physical activity (MVPA) was 51.6%. Weight status and waist-hip ratio had significant association with physical activity and sedentary activity.Conclusion: In view of the findings of this study there is an urgent need for family physicians and other health care providers to improve their communication with the public on the amounts and types of physical activity that are needed to prevent disease and promote health. If this is done, then, our sedentary society will change to one that is more physically active.Keywords: Adolescents, Physical activity, Sedentary activity, Anthropometr

Rifampicin resistant tuberculosis in a secondary health facility in Ilorin, Nigeria

Background: Rifampicin resistant tuberculosis is an unrecognized and potentially serious treatment issue. Rifampicin resistance is a risk factor for poor outcome in tuberculosis. It is prevalent in Nigeria. Therefore, we sought to examine the pattern of Rifampicin resistance tuberculosis in Ilorin, Nigeria. Method: One hundred and forty tuberculosis cases were referred to the chest clinic of Sobi Specialist Hospital, Ilorin from January to December, 2014. Sputum samples were obtained from them, smeared on glass slides, stained using Ziehl Neelsen Stain and later observed under light microscopy. The GeneXpert MTB/RIF assay was used to simultaneously detect TB and rifampicin resistance. Result: The minimum age of the patients was 18years, while the maximum was 83years. The mean age was 38.39± 13.75. There was male preponderance 84(60%), compared to 56(40%) female. The Sobi Specialist Hospital made the highest referral. The tertiary hospital, the University of Ilorin Teaching Hospital had no functional GeneXpert facility as at the time of this study. Forty eight (34.3%) had smear-positive TB, while 92(65.7%) were sputum negative. Thirty two (38.1%) male out of 84 and 12(21.4%) female out of 56 were sensitive to Rifampicin, while 6(7.1%) male out of 84 and 4 (7.1%) female out of 56 were resistant to it. Forty four (31.4%) were MD-TB positive with a prevalence of 31.4%. Ten (7.2%) were Rifampicin resistant; this included 6 males and females. This was statistically significant. Conclusion: Our study highlights that physicians should have a high index of suspicion for rifampicin resistant tuberculosis in patients refractory to anti-TB treatment. The MTB/RIF test is a useful method for rapid diagnosis of TB and detection of RIFresistance strains. There is need for increasing effort to interrupt the transmission of RIF-TB.  Keywords: Rifampicin resistant tuberculosis; Secondary health facility;  Nigeri

Physician enquiry of erectile dysfunction among hypertensives in a primary care setting, Ilorin, north-central Nigeria

Background: Erectile dysfunction(ED) among adult hypertensives is common, yet it is under-reported, under-diagnosed and undertreated in primary care. Screening and early diagnosis of erectile dysfunction will reduce its negative effects on the quality of life among hypertensive patients.This study was done at the Family Medicine Department of UITH, Ilorin, Kwara State. The aim was to assess the prevalence, severity pattern and physician enquiry of ED among adult hypertensives.Methods: This study is a descriptive cross-sectional hospital based study. Data was collected from 228 adult hypertensive male patients from June through August 2016 using the International Index of Erectile Function (IIEF-5), and semi-structured questionnaire and was analyzed with Statistical Package for Social Sciences (SPSS 20).Results: The prevalence of ED among respondents was 85.1%, mild in 22.4%, mild to moderate in 28.5%, moderate in 21.5 % and severe in 12.7%. Overwhelming percentage of the respondents (86.8%) had not been asked question related to ED by their physicians.Conclusion: This study showed that ED is a major problem and physician enquiry of ED among hypertensives is very poor. Key Words: Erectile dysfunction, Adult hypertensives, Family physicians, Primary care and Physician enquiry

Rifampicin resistant tuberculosis in a secondary Health facility in Ilorin, Nigeria

Background: Rifampicin resistant tuberculosis is an unrecognized and potentially serious treatment issue. Rifampicin resistance is a risk factor for poor outcome in tuberculosis. It is prevalent in Nigeria. Therefore, we sought to examine the pattern of Rifampicin resistance tuberculosis in Ilorin, Nigeria. Method: One hundred and forty tuberculosis cases were referred to the chest clinic of Sobi Specialist Hospital, Ilorin from January to December, 2014. Sputum samples were obtained from them, smeared on glass slides, stained using Ziehl Neelsen Stain and later observed under light microscopy. The GeneXpert MTB/RIF assay was used to simultaneously detect TB and rifampicin resistance. Result: The minimum age of the patients was 18years, while the maximum was 83years. The mean age was 38.39± 13.75. There was male preponderance 84(60%), compared to 56(40%) female. The Sobi Specialist Hospital made the highest referral. The tertiary hospital, the University of Ilorin Teaching Hospital had no functional GeneXpert facility as at the time of this study. Forty eight (34.3%) had smear-positive TB, while 92(65.7%) were sputum negative. Thirty two (38.1%) male out of 84 and 12(21.4%) female out of 56 were sensitive to Rifampicin, while 6(7.1%) male out of 84 and 4 (7.1%) female out of 56 were resistant to it. Forty four (31.4%) were MD-TB positive with a prevalence of 31.4%. Ten (7.2%) were Rifampicin resistant; this included 6 males and females. This was statistically significant. Conclusion: Our study highlights that physicians should have a high index of suspicion for rifampicin resistant tuberculosis in patients refractory to anti-TB treatment. The MTB/RIF test is a useful method for rapid diagnosis of TB and detection of RIFresistance strains. There is need for increasing effort to interrupt the transmission of RIF-TB. Keywords: Rifampicin resistant tuberculosis; Secondary health facility; Nigeri

Comparison of somnipathy among people living with HIV/AIDS (PLWHA) and HIV sero negative patients in a Nigerian family practice setting

Background: It is a common axiom that HIV sero-positive patients experience more sleep disorders than the HIV sero-negative patients, but there is paucity of research to support this claim.Objective: The aim of this study was to compare sleep disorders among PLWHA on HAART with a matched HIV sero negative control group.Method: Using the Leslie Kish's Formula, 400 PLWHA attending HIV clinic and 400 sero-negative patients attending the Well Adult Clinic of Kwara state specialist Hospital were recruited for the study. The Pittsburg Sleep Quality Index (PSQI) was used to measure sleep disorder. Body Mass Index (BMI) was calculated using the international classification. Classification of hypertension was according to the JNC 8.Results: The prevalence of sleeping disorder was 46.2% among PLWHA and 44.0% among the HIV sero-negative patients. 14.0% of PLWHA were underweight  compared with 6.0% of HIV sero-negative patients. 16.5% of PLWHA had very bad subjective sleep quality, compared with 14.8% of sero negative patients. The sleep latency was more than 60 minutes in 15.8% of PLWHA as compared with 15.0% of HIV sero negative patients. 14.5% of PLWHA slept less than 5 hours duration compared with 13.8% of HIV sero negative patients. The use of sleep medication was more among PLWHA 4.0% compared with 2.0% of HIV sero negative patients. Daytime sleep dysfunction was also more in PLWHA 77.0% compared with 68.8 of HIV sero negative patients.Conclusion: PLWHA had very bad subjective sleep quality, short sleep duration and higher sleep medication compared with HIV sero negative patients. Age, gender, educational qualification and marital status are significantly associated with sleep disorder