DIABETES RISK SCORE OF STAFF OF AN URBAN MISSION HOSPITAL IN NIGERIA

Background: Diabetes mellitus is a major global health problem which in hospital staff poses a major stress and can lead to migration away from health related posts. Certain features of health work e.g. long hours, shifts and uncertain break times increase the risk for hospital staff. It is critical to predict chronic conditions like diabetes mellitus that have a definable onset in adults so that morbidity and mortality can be mitigated through early recognition and treatment. Aims: To determine the diabetes risk score of health workers in an urban hospital and the associated risk factors. Methods and Materials: A correlational cross sectional survey of staff was conducted and diabetes risk was determined using a modified form of the Finnish Diabetes Risk Score questionnaire. Results and Conclusions: A total of 220 staff representing a response rate of 69.8% completed the study. The mean age was 41.6±9.88, Median duration of employment was 7.2years with a range of (0-37). Majority (66.4%) were in the 25-44 years age group, and most were female (66.4%) and married (70.5%). Mean BMI was 26.62±4.85. The mean Diabetes Risk score for the entire study group was 7.43±4.46 with a median score of 7 and a range of 0-19. About 40.5% had slightly elevated risk, 14.5% had moderate risk, and 5% had high risk. Female gender (AOR 0.17, 95% CI 0.09-0.33), and duration of employment (AOR 2.27, 95% CI 1.18-4.37) were significant predictors of higher diabetic risk score category. KEYWORDS: Type 2 Diabetes mellitus; Diabetes risk; Risk score; Health workforce

DIABETES RISK SCORE OF STAFF OF AN URBAN MISSION HOSPITAL IN NIGERIA

Background: Diabetes mellitus is a major global health problem which in hospital staff poses a major stress and can lead to migration away from health related posts. Certain features of health work e.g. long hours, shifts and uncertain break times increase the risk for hospital staff. It is critical to predict chronic conditions like diabetes mellitus that have a definable onset in adults so that morbidity and mortality can be mitigated through early recognition and treatment. Aims: To determine the diabetes risk score of health workers in an urban hospital and the associated risk factors. Methods and Materials: A correlational cross sectional survey of staff was conducted and diabetes risk was determined using a modified form of the Finnish Diabetes Risk Score questionnaire. Results and Conclusions: A total of 220 staff representing a response rate of 69.8% completed the study. The mean age was 41.6±9.88, Median duration of employment was 7.2years with a range of (0-37). Majority (66.4%) were in the 25-44 years age group, and most were female (66.4%) and married (70.5%). Mean BMI was 26.62±4.85. The mean Diabetes Risk score for the entire study group was 7.43±4.46 with a median score of 7 and a range of 0-19. About 40.5% had slightly elevated risk, 14.5% had moderate risk, and 5% had high risk. Female gender (AOR 0.17, 95% CI 0.09-0.33), and duration of employment (AOR 2.27, 95% CI 1.18-4.37) were significant predictors of higher diabetic risk score category. KEYWORDS: Type 2 Diabetes mellitus; Diabetes risk; Risk score; Health workforce

Areas of diabetes knowledge needs among type 2 diabetics in an urban primary care setting

Background: Knowledge is the greatest weapon in the fight against diabetes mellitus. Information can help people assess their risk of diabetes, motivate them to seek proper treatment and care, and inspire them to take charge of their disease. Objective: This study set out to find out the diabetes educational needs of adult type 2 diabetics receiving care in a primary care setting.Methods: The study was a survey of two hundred consenting type 2 diabetics receiving care at the general outpatient department of Bingham University Teaching Hospital. Socio-demographic, clinical and diabetes knowledge score data were obtained with standardized questionnaires from all the study participants. The  data was collated and analysed using SPSS (Statistical Package for Social  Sciences) software 17.0. Results were presented as statistical means and frequencies.Results: Overall, 41(28.9%) passed the diabetes knowledge test. The need for education about target blood glucose was identified by 59% of the study group, dietary choices in 53% of the study group, the need for education on foot care was identified by 42% of the entire study group, and the need for education about weight loss identified in 39% of the study group.Conclusion: The findings of this study identified knowledge of target blood glucose levels as the greatest educational need of type 2 diabetics studied. It also showed a poor knowledge of diabetes in the study group.Key words: Type 2 Diabetes, Knowledge Needs, Primary Care . [email protected]

Family physicians and the surgical disease burden in west Africa: a surgical case series

Background: Surgical disease burden is quite high in sub Saharan Africa (SSA), and is complicated by low human resource for health. These factors tend to increase thesurgical Disability Adjusted Life Years (DALYs)in SSA. Increasing the training and deployment of surgically trained generalists like Family Physicians, is a key strategy to help meet the unmet surgical needs in SSA.Methods: A retrospective review of surgical register of SIM Hospital Galmi, Niger republic, was conducted, and included all cases carried out between May 2008 and January 2009where the author was primary surgeon.Results: A total of 650 cases were carried out in the period. The mean age of the study population was 31.2 ±19.3, and they were mostly males (54.9%). Majority of the cases were major (68.6%), carried out as emergency procedures (51.5%), and involved the use of spinal anaesthesia (51.5%). General surgical conditions were commonest (46.9%) followed by obstetric indications (30.8%) and orthopaedic conditions (17.2%).Younger age groups, (χ2=78.69, p<0.001) and females (χ2=75.24, p <0.001) were more often associated with emergency presentation.Conclusion: Surgically trained Family Physicians can carry out a significant number and range of surgical procedures, and thereby reduce the unmet surgical disease burden in Sub Saharan Africa.Keywords: Family physicians, Health services' needs, sub-Saharan Africa, Surgical skill

Pattern of self-medication for acute febrile illness in the outpatient clinic of an urban tertiary hospital in Jos.

Background: Fever is a symptom of many diseases irrespective of age, sex, etc. Self medication for acute febrile illness is increasing in scope and content globally, often with severe consequences. Knowledge of the pattern of self medication for acute febrile illness can help to streamline and profer solutions to irresponsible and dangerous practices. The study set out to determine the forms and factors affecting self medication for acute febrile illness at the General Out-Patient Department (GOPD) of Bingham University Teaching Hospital (BHUTH), Jos.Methods: It was a cross-sectional study at the GOPD of BHUTH, Jos from October 2012 to February 2013. The participants were drawn from all patients with fever or history of fever of not more than two weeks duration at presentation. Data was collected with interviewer-administered structured questionaire and analysed with the Statistical Programme for Social Science (SPSS), version 21

Motivation for lifestyle change among literate obese patients in an out patient department

Background: Obesity is a chronic multifactorial disease which significantly contributes to increased morbidity and mortality from non-communicable diseases. Nutritional transition as a result of urbanization, adoption of western lifestyles and demographic transition are thought to contribute to this problem in Nigeria. Primary care physicians should be actively involved in prevention of obesity, early detection and motivating people for life style change. Motivation is an important first step towards any action or behaviour change and clinicians can assess and enhance a person's motivation to change well before extensive damage is done to health, relationships, reputation, or self-image. This study was aimed at determining the pattern of motivation to change and predictive factors among literate obese patients in a primary care setting.Methods: A cross-sectional study was conducted between July and October 2012, among literate obese patients in the outpatient setting of an urban hospital, as a first step towards a behavioural intervention in primary care. Obese patients based on BMI, were identified by clinical examination in the OPD. Readiness to change was measured with the University of Rhode Island Change Assessment (URICA) score.Results: Prevalence of obesity among literate patients in the outpatient setting was 17.43%. Most of the subjects were married (83.8%), female (76.5%) had tertiary education (64.7%) and were of the professional cadre (54.4%) while 41.1% were self-employed. Mean age was 43.5±9.2. Most earned more than forty thousand naira per month, and majority (69.1%) felt that they were motivated (self- perception) to lose weight, but most (58%) were not confident that they could lose weight (self-efficacy). Most of them had at least one co-morbidity at presentation. Based on the URICA readiness to change score, most of the literate obese patients were contemplators (73.5%), 25% were pre-contemplators, while 1.5% were in the preparation for action stage. There were no significant relationships between occupation, gender, marital status, ethnic group, age, education, income, self-perception of motivation, selfefficacy, and illness presentation, with the stage of change.Conclusion: Obesity is fairly common among literate patients in the outpatient setting. The mean readiness to change URICA score was 8.68±1.68, and most (73.5%) were in the contemplation stage.Keywords: Obesity, weight loss, lifestyle, stages of change, URIC

Risk factors for burnout among healthcare workers in an urban Hospital

Background: Health systems in developing countries face a growing challenge. Their human resources for health suffer a number of psychosocial hazards, including burnout. This study sought to determine the prevalence and risk factors of burnout using a burnout assessment approach (OLBI) in an urban hospital setting.Methods: A census of all full-time staff of the Bingham University Teaching Hospital, Jos was carried out using the Oldenburg Burnout Inventory.Results: The survey response rate was 63.3%, with 57.9% female respondents. The prevalence of burnout was 87.7%, with 136 out of 154 having an OLBI score above 2. Being a maintenance worker and an administrative staff was significantly associated with higher burnout scores (p=0.0003), while the health management and support occupational category was also significantly associated withhigher burnout scores (0.0067).Conclusion: Burnout was a relevant phenomenon in our setting, with 87.7% of health workers having burnout scores of above 2.Keywords: Burnout Inventory, Healthcare Workers, Risk Factors, Healthy Workforc

Comparison of pain response during neonatal circumcision with or without a topical anaesthetic formulation in an urban hospital in Jos, Nigeria

Background: Circumcision is the commonest surgical procedure performed in male neonates, usually without anaesthesia. Recent research had shown that new-borns have the anatomical and functional components required for perception of painful stimuli, and that unmanaged pain can have long-lasting effects on neurological function. A topical application of eutectic mixture of local anaesthetics (EMLA) has been shown to be a safe and effective method of pain control during neonatal circumcision.Objective: To determine whether topical anaesthesia (EMLA) decreases pain response during neonatal circumcision, with the overall purpose of recommending its use in Hospitals.Methods: This was a randomized, double blind intervention study that compared pain scores between neonates who had circumcision with or without topical anaesthesia. Neonates were randomly assigned to either treatment or control group. A full physical examination was done, with weight, heart rate, respiratory rate, oxygen saturation measured before and after the circumcision. Acute behavioural pain response was quantified using the Neonatal Infant pain scale [NIPS] and results compared between the two groups.Results: The mean age of the neonates in the study was 12 ±2 days. The mean of the weight for the intervention group was 3.7±0.5kg and that of the control group was 3.6±0.7kg. Also the mean of the head circumference in the intervention group was 38.4±0.3cm and that of the control group was 38.5±0.2cm. The mean of the length in the intervention group was 53.4±0.3cm and that of the control group was 53.3±0.7cm. The control and the intervention group were similar with regards to the physical characteristics. Neonates who had topical anaesthesia before circumcision had statistically, significant lower mean NIPS score compared to the control group (4.56 ±0.9 versus 5.94 ±0.2), P = 0.001. Also, they had smaller decreases in transcutaneous oxygen levels, from 96.11±1.8 to 93.3±3.2, compared to the control group, from 95.97±1.8 to 89.83±2.2. They also had smaller increases in heart rate compared to the control group, from 139.67±5.4 to 142.19±3.6 beats per minute versus, from 139.42±5.26 to 152.3±6.3 beats per minute; and respiratory rates, from 48.22±1.9 to 49.1±3.0 compared to from 48.28±1.9 to 53.2±2.9 in the control group.Conclusion: Neonates receiving topical anaesthesia before the circumcision experienced significantly less pain, smaller decreases in transcutaneous oxygen levels, smaller increases in heart rate and respiratory rate than controls.Keywords: EMLA, Local Anaesthesia, Male Circumcision, Pain Measuremen

A comparative study of group versus individual diabetes education on the diabetes knowledge among type 2 diabetics in an urban Nigerian hospital

Background: Diabetes group education is a cost effective alternative to individual education with the potential to significantly improve diabetes care. We compared the effect of group versus individual diabetes education on the diabetes knowledge test scores of adult type 2 diabetics in a primary care setting.Methods: A comparative study consisting of two hundred consenting type 2 diabetics receiving care at the general outpatient department of Bingham University Teaching Hospital was done. Subjects were recruited by systematic random sampling and randomly allocated into intervention (group education) and control (one- on- one education) in 10 blocks of 20 subjects each. Socio-demographic, clinical and diabetes knowledge score data were obtained with standardized questionnaires from both groups at 0 and 12 weeks.Results: A total of 142 patients completed the study, intervention (n = 82) and control (n = 60). Overall, 104(28.9%) passed the diabetes knowledge test (DKT),66 (80.5%) in the group education compared to 38 (63.3%) in the control group, OR 2.39 (1.12-5.09). The mean DKT score was higher in the intervention group at the end of the study, 8.48 ±2.4 vs 7.58±2.4, p=0.03. The intervention group had a similar change in mean DKT score, 2.16 vs 1.73, p=0.37. Multinomial logistic regression revealed that tertiary education was significantly related to diabetes knowledge test status (OR= 0.39; 95% CI:0.16-0.99).Conclusion: This study demonstrated poor diabetes knowledge in the entire study group before the intervention, but comparable improvement in diabetes knowledge in the two groups.Keywords: Type 2 diabetes mellitus, Diabetes knowledge, Education, Group visit

Is Simple Microscopy Useful in the Diagnosis of Asymptomatic Bacteriuria in Pregnancy in Primary Care Settings?

Background: Booked antenatal care patients are often seen with routine urine microscopy result, but there are no locally defined guidelines for the primary care physician on how to use those results. The objective of the study was to establish whether the current practice of the diagnosis of ASB in pregnancy by urine microscopy among booked women at ECWA Evangel Hospital Jos was adequate, using urine culture as a gold standard.Methods: A descriptive, cross sectional, facility-based study was carried out using a structured questionnaire administered to 184 patients between the ages of 17-42 years who gave informed consent. They had their socio-demographic data and relevant current and past medical history recorded. A physical examination was done measuring their temperature, eliciting for lower abdominal tenderness, renal angle tenderness and noting findings on speculum examination. Urine samples for urinalysis and urine culture were obtained using the clean catch mid urine technique. A white blood cell count per high power field of 2 or more seen under the microscope was considered significant for urinalysis and a single colony count of 105 was considered significant for urine culture.Results: The prevalence of ASB by urine culture was 4.9%. The correlation between urine culture and urine microscopy was 8.5%. A WBC/HPF of > 3 was found to be the most significant urine microscopy value that predicted a positive colony count. Using urine culture as a gold standard, microscopy > 2 WBC/HPF (current practice) gave a prevalence of 20.1%; sensitivity, 66.7%; specificity, 82.3%; PPV, 16.2%; NPV, 98.0%; and accuracy, 82.0%. Using > 3 WBC/HPF (proposed practice) however gave prevalence, 5.9%; sensitivity, 33.3%; specificity, 95.4%; PPV,27.3%; NPV, 96.5%; and accuracy, 92.4%.Conclusion: In a setting where urine culture is not available, the use of microscopic urinalysis > 3WBC/HPF is an alternative in detecting ASB. However, in settings where urine culture is available, patients with > 2WBC/HPF should be requested to have a urine culture.Keywords: Simple Microscopy, Useful, Diagnosis, Asymptomatic Bacteriuria, Pregnancy, Primary Car