Global disability burden and its predictors among adult Nigerians living with Type- 2 diabetes

Background: Type 2 diabetes mellitus (T2DM) is a public health issue associated with a high prevalence of disability.Studies on disability profile in terms of reduction in body structure and function, personal activities and societal participation, defined as ‘global disability’, are scarce among people living with T2DM in Nigeria.Objectives: To assess the prevalence of global disability and its predictors among Nigerian living with T2DM.Methods: A cross-sectional analysis of 162 patients diagnosed with T2DM and attending a tertiary health facility was performed for global disability measure and function. Their clinical and socio-demographic data were obtained. Poisson regression analysis was applied to assess the predicting factors of disability.Results: A mean global disability score of 22.1 was reported among the participants, varying from moderate to high in each item. About 25.0% had mild disability, while 60.5% reported moderate to severe disability. Elevated glycosylated haemoglobin, fasting blood glucose, systolic blood pressure, age, disease duration and marital status predicteddisability. A unit increase in HbA1c, systolic blood pressure and 1 month increase in DM duration had more disability reported estimates [1.062 (CI=1.050-1.075), 1.005 (CI=1.002-1.007) and 1.001 (CI=1.000-1.002) times, respectively].Married participants were 1.13 (CI=1.02-1.23) times more likely to be disabled than unmarried.Conclusions: There is mild to moderate burden and risk of global disability among Nigerian living with T2DM. Age, DM duration, marital status, fasting blood glucose, glycosylated haemoglobin and systolic hypertension significantly predicted disability.Keywords: global disability; type 2 diabetes; predicting factors; NigeriaFunding: None declare

Influence of well-being and quality of work-life on quality of care among healthcare professionals in southwest, Nigeria

The Nigerian healthcare industry is bedevilled with infrastructural dilapidations and a dysfunctional healthcare system. This study investigated the influence of healthcare professionals' well-being and quality of work-life (QoWL) on the quality of care (QoC) of patients in Nigeria. A multicentre cross-sectional study was conducted at four tertiary healthcare institutions in southwest, Nigeria. Participants' demographic information, well-being, quality of life (QoL), QoWL, and QoC were obtained using four standardised questionnaires. Data were summarised using descriptive statistics. Inferential statistics included Chi-square, Pearson's correlation, independent samples t-test, confirmatory factor analyses and structural equation model. Medical practitioners (n = 609) and nurses (n = 570) constituted 74.6% of all the healthcare professionals with physiotherapists, pharmacists, and medical laboratory scientists constituting 25.4%. The mean (SD) participants' well-being = 71.65% (14.65), QoL = 61.8% (21.31), QoWL = 65.73% (10.52) and QoC = 70.14% (12.77). Participants' QoL had a significant negative correlation with QoC while well-being and quality of work-life had a significant positive correlation with QoC. We concluded that healthcare professionals' well-being and QoWL are important factors that influence the QoC rendered to patients. Healthcare policymakers in Nigeria should ensure improved work-related factors and the well-being of healthcare professionals to ensure good QoC for patients

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Developmental Pattern of Tibio-Femoral Angle in a Cohort of Nigerian Children: A Preliminary Report

A cohort measurement of tibio-femoral angle (TFA) is more meaningful and reliable than a cross-sectional survey in investigating TFA pattern of development. This study reports the pattern of knee angle development in a cohort of 152 normal Nigerian children during the first 12 months of life. The infants’ tibio-femoral angle, inter-condylar, and inter-malleoli distances were measured at monthly intervals using clinical methods. Age-reference values were generated. Results showed that the developmental pattern of tibio-femoral angle is extreme varus at birth with values ranging from 5°to 25°. The mean varus at birth (13.2±3.7°) decreased to reach the lowest value (5.6±0.7°) at nine months and then rose slightly to (6.9±1.2°) at 12 months. None of the infants exhibited a measurable valgus angle. In conclusion, the chronological development of TFA in these cohort Nigerian infants was varus, maximal at birth and decreasing during first 12 months of life. The age-reference values herewith generated may serve as a useful guide in evaluating lower limb alignment in Nigerian children, age 0 to 12 months

Exploring the life experiences of stroke survivors in Nigeria using the interpretive phenomenological analysis

Abstract Background The consequence of living as a stroke survivor has received significant attention in literature from different parts of the world. Enriching social relations and other factors are reported to influence the post-stroke experience. Differences in health systems, cultural factors and available resources have made it apt to explore the experience of life after a stroke in Nigerian stroke survivors. This study explored the lived experiences of Nigerian adult stroke survivors, with a focus on their concerns, hopes, dreams and daily routine experiences. Methods This qualitative study employed a phenomenological approach based on in-depth interviews with stroke survivors. Interpretative phenomenological analysis was used to analyse the in-depth exploration of the personal experiences of these stroke survivors and the meanings they attached to that experience. Results The participants in this study described their experiences, emphasising both the visible loss of mobility and emotional issues related to their condition. Three superordinate themes were identified: (1) stroke presentation; (2) affect, coping, and adaptation; and (3) social supports. Conclusion The study concluded that the experience of Nigerian stroke survivors is unique as it is a blend of supportive and non-supportive care scenarios, which is greatly associated with environmental and other intrinsic variables. Post-stroke mobility strongly influences the overall stroke experience

Characteristics and determinants of community physiotherapy utilization and supply

Abstract Background Demand for Physiotherapy is on the rise due to increasing ageing population and consequent disability and morbidity. However, the costs of healthcare in developing countries are rising, and healthcare resources are limited making the supply of Physiotherapy services challenging in rural communities. Availability of Physiotherapy may help to reduce the burden of disability and enhance efficiency of healthcare systems. This study investigated the characteristics and associations of utilization and supply of community Physiotherapy in Nigeria. Methods Cross-sectional survey of 336 consenting community dwelling individuals from three selected communities in Nigeria was carried out. A three-section validated self-developed questionnaire which sought information on socio-demographics, utilization and supply of community Physiotherapy, as well as how to improve community Physiotherapy services was used. A household was used as the primary sampling unit in the study. Inferential and Descriptive statistics were used to assess the data. Results Lifetime, 12-month and point utilization of physiotherapy was 21.7, 7.4 and 2.7% respectively. Physiotherapy utilization was significantly associated with level of education (p = 0.007), belief on pain as “spiritual” (p = 0.020) and religious belief (p = 0.001). The respondents with primary, secondary and tertiary education were 14.3, 13.9 and 26 times more likely to utilize physiotherapy services, respectively. Those who ‘agree’ or were ‘not sure’ that their religious belief was against physiotherapy were 92 and 83% less likely to utilize physiotherapy services, respectively compared with those who ‘disagree’. Availability and supply of Physiotherapy services were mostly at the township teaching hospital (47.9%) and private hospitals (20.5%). The supply of Physiotherapy services within the communities was mostly on temporary basis (24.7%) and through visiting Physiotherapists (21.4%). Physiotherapy services utilized was mainly exercise (46.6%) and soft tissue mobilization (41.1%). Travel costs (32.6%), time constraints (27.9%) and work commitments (24.8%) were the constraints for Physiotherapy utilization while positive beliefs and higher education improved Physiotherapy utilization. Conclusions Utilization and supply of Physiotherapy services in Nigerian rural community was low. Low utilization of Physiotherapy services in Nigerian rural communities were most significantly influenced by low educational status and beliefs about pain

Development and clinimetric testing of willingness to pay tool for physiotherapy

Background: Lack of technical knowledge on Willingness to Pay (WTP) for health services may have contributed to paucity of WTP studies in physiotherapy. Objective: To develop and establish clinimetric properties of WTP tool for physiotherapy. Methods: A WTP tool with five sections exploring information on socio-demographics, physiotherapy experience, satisfaction with physiotherapy, cost of physiotherapy services and patients’ preferences for physiotherapy was developed. The WTP tool was tested for content validity, readability and thereafter completed on test–retest after one-week interval by 97 consenting physiotherapy outpatients. Intra-class correlation coefficient (ICC) with 95% confidence intervals and Cronbach’s alpha (α) were used to assess the data for reliability and internal consistency. Results: The tool's readability indicated a Flesch-Kincaid Grade Level and Reading Ease scores of 5.6 and 66.7 respectively. ICC for aggregate score of ‘patients’ satisfaction’ was ‘moderate’ (0.644, p < 0.05), while the ‘cost of physiotherapy services’ section was ‘excellent’ (0.837, p < 0.05). The internal consistency of the ‘satisfaction with physiotherapy’ (0.783, p < 0.05) and ‘cost of physiotherapy services’ (0.911, p < 0.05) sections were ‘excellent’. The stability of the different sections of the instrument over one week period, as reflected by the ICC, ranged from ‘poor’ to ‘excellent’. Also, the Cronbach’s alpha and the ICC for the WTP characteristics were ‘poor’ to ‘excellent’, respectively. Conclusion: The WTP tool for physiotherapy appears comprehensible and reliable among patients with chronic conditions attending the physiotherapy clinic. Availability of this WTP tool will promote studies examining the demand for physiotherapy services

Missed physiotherapy appointment and its influence on cost, efficiency and patients’ outcomes

Background: Missed appointments (MAs) is a significant challenge to efficient running of physiotherapy departments and it has cost implications. In this study, wait time and the pattern and impact of MAs on cost, efficiency, and patient outcome was assessed among Nigerian patients receiving physiotherapy. Method: In this retrospective study a total of 3243 physiotherapy appointments booked between 2009 and 2019 at an Outpatient Physiotherapy Clinic in Nigeria. were conducted. Data were gleaned on socio-demographic and patient outcomes related to MAs. The total revenue loss due to MAs was calculated as a product of the total of MAs and per treatment cost. Results: MAs constituted 1701 (52.5%) of all appointments and the average wait time for the first appointment was 9.6 ± 23.2 days. The proportion of MAs was higher among females (50.2%), patients who were not residents within the same location as the clinic (45.3%), patients with orthopaedic conditions (56.2%) and patients referred from an orthopaedic surgeon (32.8%). Females, those who live far within the city, and those with neurological/medical conditions were 1.68, 1.24, and 1.52 times more likely to have MAs compared with males (OR = 1.68, CI = 1.44 – 1.96, p = < 0.001), and those who live outside the city (OR = 1.24, CI = 1.05 – 1.46, P = 0.01), and have orthopaedic conditions (OR = 1.52, CI = 1.20 – 1.93, p = <0.001), respectively. Using per treatment schedule cost of N1000 (an equivalent of $2.31), a 52.5% MAs rate resulted in lower efficiency of 76.6% with an efficiency ratio of 0.23. Further, a 52.5% MAs rate could potentially impact patient recovery by 3402 days if MAs slow a patient recovery process by 2 days. Conclusions: MAs for physiotherapy treatment pose a significant challenge in terms of costs, efficiency, and patient outcomes. Thus, an innovative reminder system may help reduce patients’ non-attendance to physiotherapy and its consequences

Willingness-to-pay for physiotherapy services and its determinant among Nigerian stroke survivors

Purpose: This study was aimed to examine willingness-to-pay (WTP) for physiotherapy services among stroke survivors, and to explore the determinants of WTP in terms of socio-demographic factors, satisfaction with treatment and Health Related Quality of Life (HRQoL). Methods: A total of 68 stroke survivors had their WTP, HRQoL and satisfaction with physiotherapy treatment assessed using Willingness-to-pay questionnaire, Stroke Specific Quality of Life Questionnaire, and Physical Therapy Outpatient Satisfaction Survey, respectively. Data was analysed using descriptive and inferential statistics. Results: A total of 63.2% expressed WTP for physiotherapy per visit. Majority of the respondents had high HRQoL (66.2%) and satisfaction with physiotherapy (55.9%) respectively. There was a significant association between WTP for physiotherapy and educational status (χ²=6.248; p=0.044). Stroke survivors with tertiary education were six times more likely to have WTP for physiotherapy services compared with those who had primary education (OR=6.009, CI=1.528 – 23.630, P=0.01). Stroke survivors with right side affectation were five times more likely to have WTP for physiotherapy compared with those with left side affectation (OR=5.109, CI=1.305 – 19.997, P=0.019). There was no significant association between WTP for physiotherapy and each of HRQoL and satisfaction with treatment (p > 0.05). Conclusion: A high proportion of Nigerian stroke survivors attending public health facility expressed WTP for physiotherapy and it is influenced by educational status and side of affectation