Patients' Perception of Quality of Diabetes Care Received in Ibadan, Nigeria.

Diabetes Mellitus (DM) is one of the diseases of public health concerns of the 21st century with rising burden in developing countries. The evaluation of care for diabetes from patients' perspective an important indicator of measuring quality of health services and improving treatment approaches but data of the nature are scarce in Nigeria. The study therefore investigated Patients' Evaluation of the Quality of Diabetes care (PEQD) in Ibadan. This descriptive cross-sectional study recruited 384 diabetic patients from three hospitals where specialised services are offered in Ibadan. A semi-structured pre-tested questionnaire was used to collect data. A 42-point PEQD questionnaire scale was used to collect data and a score of >21 was rated as good Perceived Quality of Care (PQC). Data were analysed using descriptive statistics, chi-square test and logistic regression set at 5% level of statistical significance. Mean age of respondents was 62.5 + 10.8 years and mean diabetes duration was 8.4 + 7.6. Majority (58.3%) of the respondents didn't know the type of diabetes they had. Patients aged less than 60 years were less likely to PQC received as good (OR: 0.21; CI: 0.05 - 0.91) compared to those who were above 60 years. More than half (55.0%) of the respondents perceive quality of care as good. Patients' assessment of the quality of diabetes care received was perceived good. There is need to sustain current satisfactory services in diabetic care and institutionalize periodic survey patients' satisfaction to provide feedback for future quality improvement.

Treatment Satisfaction and Medication Adherence Among Hypertensive Patients Seeking Care in Selected Hospitals in Ibadan, Nigeria.

Poor adherence to hypertension treatment is a major health-related problem, and a significant risk factor for complications, disability and hypertension associated mortality. There is a paucity of evidence on the impact of treatment satisfaction on medication adherence among hypertensive patients in Nigeria. This study aimed to determine the association between treatment satisfaction and medication adherence among hypertensive patients in Ibadan, Nigeria. A descriptive cross-sectional study was conducted, wherein hypertensive patients were consecutively recruited from 5 hospitals in Ibadan, Nigeria. A pre-tested, interviewer-administered questionnaire was used to collect data. Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8), and treatment satisfaction using the 9-item Treatment Satisfaction Questionnaire for Medication (TSQM). Descriptive statistics were computed for all variables. Bivariate analysis was carried out using chi-square test, and multivariate analysis using binary logistic regression. Sensitivity analysis was conducted to adjust for unmeasured binary confounders. Statistical significance was set at p < 0.05 for a 2-tailed. A total of 342 respondents with the mean age of 59.6 ± 12.6 years participated in the study. The overall prevalence of medication adherence was 35.1% (MMAS-8 scores = 8). Treatment satisfaction (AOR=2.03, 95% CI: 1.21-3.43) was independently associated with medication adherence. Sensitivity analysis revealed that the observed association between treatment satisfaction and medication adherence was unlikely to be due to unmeasured confounding variables. Medication adherence was low, and treatment satisfaction independently increases medication adherence. Treatment satisfaction strategies should be part of any treatment intervention packages in this population.

KNOWLEDGE, ATTITUDE AND CONTROL PRACTICES OF SICKLE CELL DISEASE AMONG YOUTH CORPS MEMBERS IN BENIN CITY, NIGERIA.

BACKGROUND: Sickle cell disease (SCD) is a major public health problem in Nigeria. Carrier prevalence is about 25% and it affects about 2 - 3% of the Nigerian population. The disease runs a chronic course, characterized by recurrent ill-health, progressive organ damage and shortened life-span. There is a need for SCD control through public education and other preventive measures. OBJECTIVE: This study aimed at assessing the level of knowledge regarding SCD among a cross-section of new tertiary graduates in Nigeria, as well as factors influencing their knowledge. It also describes their attitudes and patterns of control practices engaged by the respondents regarding SCD. METHOD: This was an analytic, cross-sectional study among 370 new tertiary graduates (youth corps members) in Benin City, Nigeria. Bio-data, data on knowledge, their attitude and control practices of sickle cell disease were obtained using a structured questionnaire. Association between the mean level of knowledge and other variables such as age, gender, course of study, etc were tested using one way analysis of variance. RESULTS: Most of the study participants were aged 22 - 29 years. A large proportion (63.5%) of the respondents was females. Only 17.8% of the respondents had a good knowledge of SCD despite high level of awareness (98.4%). Those who studied courses related to medical sciences had significantly higher mean knowledge score. About 94.6% of the respondents knew their SCD carrier status and 80.8% were willing to avoid carrier marriages. Only 38.1% will accept prenatal diagnosis/selective abortion if locally available. CONCLUSION: Most participants demonstrated moderate level of public health knowledge regarding SCD in Nigeria. Considering the relative lack of prenatal diagnostic services, low acceptability of selective abortion among the respondents, sub-optimal care of affected persons and poor access to haemopoeitic stem cell transplantation (HSCT) in our environment, stronger efforts should be directed and sustained at primary prevention through public education and screening regarding SCD.

Knowledge and use of emergency contraception by medical doctors on internship in a tertiary healthcare facility in Nigeria.

CONTEXT: Emergency contraception (EC) is widely used to prevent unwanted pregnancy and it is largely adopted in many countries as over the counter drug to improve access. AIMS: To determine and compare the correct knowledge, attitude and current use of EC among newly graduated medical doctors (MDs). SETTINGS AND DESIGN: A cross-sectional study conducted among 255 newly graduated MDs at the University College Hospital, Ibadan, Nigeria. MATERIALS AND METHODS: A pretested self-administered questionnaire was used to obtain data from consenting participants. STATISTICAL ANALYSIS USED: Descriptive, bivariate, and multivariable analyses were performed, and statistical significance was set at 0.05. Statistical Package for Social Science version 15.0 (Chicago, IL, USA) software was used. RESULTS: The mean age of the respondents was 27.2 years (standard deviation = 2.1). The commonest indication for emergency contraceptive use mentioned was rape-96.5%. About 70% support EC in Nigeria, while about a quarter (26.9%) routinely counsel women about ECP use. About 21% of respondents currently use EC. Logistic regression analysis revealed significant results for gender [odds ratio (OR) =3.64; 95% confidence interval (CI) OR = 1.31-10.01), religion (OR = 0.26; 95% CI OR = 0.11-0.630) and marital status (OR = 0.19; 95% CI = 0.07-0.56). CONCLUSION: The correct knowledge and professional disposition toward EC as a form of contraception is low. We recommend that in-service training should focus more on EC to improve the quality of their knowledge and attitude towards it.

Prevalence and correlates of mental health problems among awaiting trial inmates in a Prison facility in Ibadan, Nigeria.

INTRODUCTION: Prevalence of mental health problems are frequently higher within the prison populations than the general population. Previous studies of prison mental health had focused on convict populations whereas, the awaiting trial segment of the prison population in Nigeria has gradually become the majority of the total lock-up. This study aimed to evaluate the prevalence and correlates of mental health problems among the awaiting trial inmates in a prison facility in Ibadan. METHODS: A cross sectional study design was employed to interview 725 awaiting trial inmates of Agodi Prison, Ibadan, Nigeria. A two phase procedure was utilized with initial screening using a socio-demographic questionnaire and the General Health Questionnaire (GHQ -12); followed by a second phase with all high scorers on the GHQ -12 and 10% of the low scorers using the MINI International Neuropsychiatric Inventory (MINI). RESULTS: A total of 394 respondents participated in the second phase of the study with a mean age of 31.1 years (SD = 8.7), with ages ranging from 18 - 70 years. The mean duration of incarceration at Agodi was 1.1 years (SD = 1.47), with a range of 1 week to 10 years. The prevalence of mental illness was 56.6% with the commonest conditions being depression (20.8%), alcohol dependence (20.6%), substance dependence (20.1%), suicidality (19.8%) and antisocial personality disorder (18%). CONCLUSION: There is a high prevalence of neuropsychiatric disorders among awaiting trial inmates but this does not appear to be significantly different from that of convict populations.

Cervical ripening and induction of labour-awareness, knowledge and perception of antenatal attendees in Ibadan, Nigeria.

The levels of awareness, knowledge and the perceptions of women about cervical ripening and induction of labour were assessed in a cross-sectional questionnaire-based interview of 265 antenatal attendees of the University College Hospital, Ibadan, Nigeria from 1 March to 30 April 2009. Questions included evaluated sociodemographic data, obstetric history, awareness of both procedures and knowledge of specific methods. Data analysis was done using SPSS v.14.0 for Windows; frequency tables were utilised to determine proportions and significant variables from χ(2) analysis were entered into a logistic regression model. The majority of respondents were between 26 and 34 years; 56.4% were nulliparous. Awareness of cervical ripening and induction of labour was found in 71% of respondents. Knowledge of misoprostol and Foley's catheter however, was present in 25% and 13% of all women, respectively. Both procedures were perceived to prevent caesarean section or reduce burden of health workers in 16% of respondents. No significant predictor of knowledge was found but history of previous induction was a predictor of awareness (p < 0.05). Improved counselling is required to further increase knowledge of methods for induction and correct wrong perceptions, particularly in women at risk of labour induction.

Mammographic breast pattern in Nigerian women in Ibadan, Nigeria.

INTRODUCTION: Mammographic breast density is dependent on the relative proportion of radiolucent fat and radio-dense connective and glandular tissue. This breast density is said to be a marker of risk for breast cancer and has received widespread interest in many countries in recent years. AIMS AND OBJECTIVES: The main objective of this study is to estimate the prevalence of the various mammographic breast density patterns and seeks to find any association between the reported breast patterns and various demographic variables in women in Ibadan, South West Nigeria. METHODS: A prospective descriptive study of mammographic breast pattern in 498 women at the Department of Radiology, University College Hospital Ibadan. Two screening views and additional views when necessary were done on each breast with the Senographe DMR+ Mammographic Unit. Participants also completed an assisted administered questionnaire which was used to obtain data on their socio-demographic characteristics. RESULTS: The study confirmed significant association with age and parity as in previous reports in the diaspora. CONCLUSION: The study confirmed denser mammographic breast pattern in younger and nulliparous women. Future work on mammographic density and other variables is contemplated for complete cancer related data in our peculiar setting.

Cost of epilepsy in children attending a tertiary centre in Nigeria.

Epilepsy is one of the leading paediatric neurological disorders in Nigeria and many other parts of the world. There is very little documented on the economic costs of epilepsy in Nigeria and other countries in sub-Saharan Africa. This study was carried out to estimate the total cost of childhood epilepsy in a cohort of Nigerian children and therefore provide essential information on the economic burden of childhood epilepsy in Nigeria. A cost of illness study was performed on a cohort of 215 consecutive cases of epilepsy seen and treated at the University College Hospital, Ibadan, Nigeria. Data on demographics, clinical characteristics, utilization of resources and costs were collected. The total annual cost of epilepsy ranged from Nigerian naira (N)23 200 (US$155) to N3 298 500 (US$21,900) with a median of N107 600 (US$717) per patient per year. Direct medical and non-medical costs accounted for 71.8% of the total mean annual cost of epilepsy. Anti-epileptic drug therapy and in-patient care accounted for 21.8% and 33.0% of the mean total annual cost respectively and more than half of the families expended over 20% of their total family income on the care of the child with epilepsy. The economic burden of childhood epilepsy in Nigeria is enormous with very high out-of-pocket expenses.

Seroprevalence of bovine brucellosis in trade cattle slaughtered in Ibadan, Nigeria, from 2004-2006.

A seroprevalence study was carried out among trade cattle slaughtered at Bodija Municipal Abattoir, Ibadan (southwestern Nigeria) over a period of 3 consecutive years from 2004 to 2006 with a view to determining the breed, sex and age distribution in the seropositivity of bovine brucellosis. In total, 1642 animals were examined for antibodies to Brucella abortus using the Rose Bengal test. Seroprevalences of 6.00%, 6.17% and 5.31% were obtained in the years 2004, 2005 and 2006, respectively but a decrease in 2006 shows no significant difference (P > 0.05). The role of the breed (P > 0.05), sex (P > 0.05) and age (P > 0.05) in the occurrence of the infection was not statistically significant at 5%, although higher rates were obtained for females and older animals. The trend in the disease over the 3-year period showed that it is endemic in trade cattle slaughtered in Ibadan and the public health implications of this are discussed.

Children not receiving adequate immunization in Ibadan, Nigeria: what reasons and beliefs do their mothers have?

BACKGROUND: Immunization coverage in most areas in Nigeria has remained low with continued high morbidity and mortality from vaccine preventable diseases. OBJECTIVES: To identify the reasons and beliefs about immunization among mothers whose children have not received adequate immunization or not at all. SUBJECTS AND METHODS: The study was a descriptive cross sectional survey that involved mothers trading in a large market in Ibadan who had children between the ages of 12 and 23 months. Data were collected by means of a semi-structured questionnaire. Mothers who did not immunize or failed to completely immunize their children were selected for analysis. RESULTS: A total of 248 mothers were interviewed, their mean age was 27.3 5.5 years (range 16 42 yrs). The commonest reasons for incomplete immunization included: non availability of vaccines (26.2%), not being aware of need for additional doses (16.5%) and inconvenient time/venue (13.7%). Logistic regression analysis showed that Mothers with no formal education were about six times more likely than those with secondary education and higher to give reasons related to lack of motivation (95% CI OR = 1.88 17.93). Analysis of the mothers' beliefs on immunization were as follows; 186 (75.0%) believed it was beneficial, 161 (64.9%) believed that immunization will save the life of the child and 129 (52.0%) believed that taking the child to the clinic for immunization wasted a lot oftime. CONCLUSION: Most mothers in this study agreed that immunization is beneficial. It is therefore recommended that routine immunization be strengthened, vaccines made readily available and mothers educated on the immunization schedule.

Immunization status and its determinants among children of female traders in Ibadan, South-Western Nigeria.

Traders form a large percentage of the female work force in Nigeria and may spend long hours at work, thereby putting their children at risk of inadequate immunization. The study assessed primary immunization completion rate and the determinants of immunization status among the children of female market traders in Ibadan, South-Western Nigeria. A cross-sectional community-based survey was carried out in Bodija market among female traders who had children aged 12 to 23 months. The subjects were selected by systematic random sampling and data collected with an interviewer administered semistructured questionnaire. Logistic regression was used to estimate the predictors of incomplete immunization for the socio-demographic variables. A total of418 women were interviewed. Ninety two percent worked > or = 6 days a week and 78.5% had their children with them in the market all the time. Full immunization by both card and history was recorded in only 40.7% while 8.4% children had never been immunized. The highest vaccine coverage was seen with BCG (91.4%) while Hepatitis B (1%) had the lowest coverage. DPT1 to DPT3 vaccine drop out rate was 32.1%. All the immunizations were received in health facilities. The immunization coverage rate among children of female traders was low. Routine immunization sites should be made available in the markets.

Determinants of post-caesarean wound infection at the University College Hospital Ibadan Nigeria.

OBJECTIVE: To determine the risk factors that predispose patients to post-caesarean wound infection at a tertiary health institution in developing country. METHOD: It was an observational study of all women that had caesarean (elective and emergency) delivery between July and September, 2004. The outcome of their post-caesarean wound was assessed. Statistical analysis (Bivariate and logistic regression) of the identified risk factors in patients who developed wound infection was performed at a 95% level of confidence. RESULTS: The post-caesarean wound infection rate was 16.2%. The identified risk factors were lower educational status, multiple pelvic examination, offensive liquor at surgery and patients that are unbooked. Following logistic regression, women with up to primary school were 20 times more likely than those with secondary education and above to develop wound infection (95% CI OR = 1.8 to 250.0). CONCLUSION: The outcome showed that the identified determinants of post-caesarean wound infection were comparable with earlier reports. Women with lower educational status are more at risk in this study. Therefore, these women need special attention to reduce the risk.

Uncomplicated midvaginal vesico-vaginal fistula repair in ibadan: a comparison of the abdominal and vaginal routes.

BACKGROUND: Obstetric fistula is a resultant effect of prolonged obstructed labour. The best surgical management of simple uncomplicated fistula determines the outcome of care. OBJECTIVE: To compare outcome of uncomplicated mid-vaginal fistula between vaginal and abdominal route of repair. MATERIALS AND METHOD: This was a hospital based retrospective study conducted at the University College Hospital, Ibadan from January, 2000 till December, 2006. RESULT: Of the 71 midvaginal fistulae managed, 40.8% had abdominal repair while the remainder were through vaginal approach. The overall repair success rate was 79.2% with comparable outcome in both groups-78.3% for the abdominal and 80% for the vaginal group (p=0.999). The duration of hospital stay did not differ significantly between the groups (p=0.972). Post operative complications were found in 41.4% of the abdominal group compared to none in the vaginal group (p<0.001). The complications were failed repair (20.7%) and urinary tract infection (20.7%). The mean estimated blood loss was 465.5ml in the abdominal group compared to 332.9ml for the vaginal group (p=0.303). CONCLUSION: Despite the comparable surgical repair outcome of the two methods, the vaginal approach is associated with lesser blood loss and lower risk of post-operative complications. It is recommended that the vaginal route should be employed in the repair of uncomplicated midvaginal fistula unless there are other compelling reasons to the contrary.

Attitude and preferences of nigerian antenatal women to social support during labour.

SummaryThis was a hospital-based cross-sectional study of 224 randomly selected antenatal women receiving care at the University College Hospital, Ibadan, Nigeria. The study aimed to seek the attitude and preferences of respondents about social support during childbirth and also identify variables that may influence their decisions. Seventy-five per cent of respondents desired companionship in labour. Approximately 86% preferred their husband as companion while 7% and 5% wanted their mother and siblings as support person respectively. Reasons for their desire for social support were emotional (80.2%), spiritual (17.9%), errands (8.6%) and physical activity (6.8%). Socio-demographic variables found to be statistically significant on logistic regression analysis for the desire of a companion in labour were nulliparity (OR 3.57, 95% CI 1.49-8.52), professionals (OR 3.11, 95% CI 1.22-7.94) and women of other ethnic groups besides Yoruba (OR 2.90, 95% CI 1.02-8.26), which is the predominant ethnic group in the study area. Only those with post-secondary education were found to want their husbands as doula (OR 2.96, 95% CI 1.08-8.11). More than half of the respondents wanted information about labour prior to their experience. It is important that Nigerian women are allowed the benefit of social support during childbirth, particularly as there is a lack of one-to-one nursing care and other critical services, including epidural analgesia in labour, at many of the health care facilities in Nigeria. Men could play a pivotal role in the process of introducing support in labour so as to improve the outcome for both the mother and her newborn.