Uncovering the Burden of Diabetes in Ekiti State, Nigeria: Insights From a Statewide, Household-Based, Cross-Sectional Study.

INTRODUCTION: Diabetes mellitus (DM) is an important global public health challenge, and the burden of the disease is huge, particularly in low- and middle-income countries (LMICs), where the majority of people with this condition reside. Undiagnosed DM is more prevalent in LMICs. The aim of this study is to determine the prevalence and associated factors for DM in Ekiti State. MATERIALS AND METHODS: A cross-sectional, household-based survey using a four-stage multistage sampling design and the World Health Organization (WHO)-STEPS survey manual was conducted from July to September 2020 as a part of the Ekiti State coronavirus disease 2019 (COVID-19) survey. Of the 5,145 sampled households, 4,726 individuals gave consent to participate in the survey. Out of these, 3043 had fasting plasma glucose results available and were included in the analysis. RESULTS: There were 2257 (74.2%) women and 786 (25.8%) men. The prevalence of DM was 6.5% (6.5% in males and 6.6% in females, P = 0.946). Diabetes was found to be more prevalent among those with a secondary school education or higher (10.9%); employed in the formal sector (13.4%); separated, divorced, or widowed (8.5%); with raised blood pressure (9.3%); and who were aged 30-59 years (all P < 0.05). Multivariable logistic regression showed that age, education, occupation, and hypertension were all positively and significantly associated with an increased risk of DM. CONCLUSION: The prevalence of DM in Ekiti State is high, and its predictors include advancing age, hypertension, education, and occupation. This calls for scaling up public health interventions for controlling DM, targeting the identified risk factors among the people of Ekiti.

Family support and medication adherence among adult type 2 diabetes: Any meeting point?

Background: Serious disability diabetes mellitus (DM) cause for patients and their support system-family and friends are enormous. It remains an important public health challenge, despite effective medical therapies for its management; patients' poor adherence remains a global problem. Objective: The study assessed the relationship between family support and medication adherence among adult Type 2 DM (T2DM) attending family medicine clinic of a rural tertiary hospital. Methodology: This was an analytic cross-sectional hospital-based study carried out among 367 patients selected by systematic random sampling method. Relevant data collected through a semi-structured questionnaire and clinical data recorded and fasting plasma glucose (FPG) were utilized for the study. Data were analyzed using SPSS version 16. Results: The mean (standard deviation) age of respondents was 61.7 ± 11.4 years. Those with strong family support that achieved medium/high (Morisky Medication Adherence Scale-8 > 6) level of medication adherence (odds ratio [OR] [95% confidence interval (CI)] = 1 6.4 [9.1-29.6], P < 0.001) constituted 69.5% of respondents. Family support was also found to have a direct relationship to glycemic control (FPG < 7.1 mmol/l), 65.7% of those with strong family support achieved good glycemic control, P < 0.001, OR (95% CI) = 17.4 (9.2-37.2). The level of medication adherence was noted to be directly related to glycemic control, 79.4% of those with medium/high medication adherence had good glycemic control, OR (95% CI) = 25.0 (14.4-43.6), P < 0.001. Strong family support leads to higher medication adherence level which resulted into better glycemic control. Conclusion: Family support improves medication adherence and glycemic control. Physicians should explore patients' family support system to improve medication adherence level and better management outcome of chronic diseases especially T2DM.

RésuméContexte: La cause du diabète sucré d'invalidité grave pour les patients et leur système de soutien - famille et amis est énorme. Il reste un défi de santé publique important, malgré des thérapies médicales efficaces pour sa gestion; La mauvaise observance des patients reste un problème mondial. Objectif: L'étude a évalué la relation entre le soutien familial et l'observance des médicaments chez les adultes atteints de diabète sucré de type 2 (DT2) fréquentant la clinique de médecine familiale d'un hôpital tertiaire rural. Méthode: Il s'agissait d'une étude analytique transversale en milieu hospitalier menée auprès de 367 patients sélectionnés par la méthode d'échantillonnage aléatoire systématique. Les données pertinentes collectées à travers un questionnaire semi-structuré et les données cliniques enregistrées et la glycémie à jeun ont été utilisées pour l'étude. Les données ont été analysées à l'aide de la version 16 de SPSS. Résultat: l'âge moyen (ET) des répondants était de 61,7 ± 11,4 ans. Les personnes bénéficiant d'un fort soutien familial et ayant atteint un niveau d'observance médiatique moyen / élevé (MMAS-8> 6) {OR (IC 95%) = 16,4 (9,1 - 29,6), p <0,001} constituaient 69,5% des répondants. Le soutien familial a également une relation directe avec le contrôle glycémique (FPG <7,1 mmol / l), 65,7% des personnes bénéficiant d'un soutien familial solide ont obtenu un bon contrôle glycémique, p <0,001, OR (IC à 95%) = 17,4 (9,2 - 37.2). On a noté que le niveau d'observance du médicament était directement lié au contrôle glycémique, 79,4% des personnes ayant une observance moyenne / élevée du médicament avaient un bon contrôle glycémique, OR (IC à 95%) = 25,0 (14,4 - 43,6), p <0,001. Un fort soutien familial conduit à un niveau d'adhésion aux médicaments plus élevé, ce qui se traduit par un meilleur contrôle glycémique. Conclusion: le soutien familial améliore l'observance des médicaments et le contrôle glycémique. Les médecins devraient explorer le système de soutien familial des patients afin d'améliorer le niveau d'observance des médicaments et de mieux gérer les résultats des maladies chroniques, en particulier le DT2. Mots clés: soutien familial, adhésion aux médicaments, DT2, contrôle glycémique.

Glycemic control and its association with sociodemographics, comorbid conditions, and medication adherence among patients with type 2 diabetes in southwestern Nigeria.

OBJECTIVE: We determined the prevalence of poor glycemic control and associations with sociodemographics, comorbid conditions, and medication adherence among patients with type 2 diabetes mellitus (T2DM) at a tertiary hospital in southwestern Nigeria. METHODS: We conducted a retrospective observational study among 300 patients with T2DM using systematic random sampling. We used a semi-structured questionnaire to collect information on respondents' sociodemographic profile, lifestyle, comorbid conditions, and antidiabetic medications. Adherence was determined using the Morisky Medication Adherence Scale. Fasting blood samples were tested using a glycated hemoglobin marker. Multivariate logistic regression was used to identify factors associated with poor glycemic control. RESULTS: Respondents' mean age was 61.9 ± 11.8 years. The prevalence of poor glycemic control was 40.0% (95% confidence interval [CI]: 34.4%-45.8%). The adjusted odds ratio (95% CI) for factors associated with poor glycemic control was 2.522 (1.402-4.647) for older age, 1.882 (1.021-3.467) for low income, 1.734 (1.013-3.401) for obesity, 2.014 (1.269-5.336) for non-initiation of insulin therapy, and 1.830 (1.045-3.206) for poor medication adherence. CONCLUSION: Older age, lower income, obesity, non-initiation of insulin, and poor medication adherence were associated with poor glycemic control. These variables may help clinicians identify patients at high risk of poor glycemic control.

Prevalence of inappropriate medication prescription in the elderly in Nigeria: A comparison of Beers and STOPP criteria.

BACKGROUND: Inappropriate medication prescription among the elderly is a major problem with significant negative health consequences. The Beers and STOPP (Screening Tool of Older Persons' potentially inappropriate Prescription) criteria are common tools used for screening of potentially inappropriate medications. The primary objective of the study was to estimate the incidence of PIM among elderly Nigerian patients using the earlier mentioned tools. METHODOLOGY: This prospective study was conducted among elderly patients attending the general outpatients' clinics of two tertiary healthcare institutions in the South-Western part of Nigeria. The patients' age, gender, diagnosis for which the patient was receiving treatment and prescribed drugs were the information retrieved from the medical records. The WHO drug use indicators were applied in the drug utilization aspect of the study while the Beers and STOPP criteria were used to define the inappropriateness or otherwise of the prescribed medications. RESULTS: The mean number of drugs per prescription was 4.1 ± 1.2 while the median number of drugs prescribing by generic name was 46.5% (IQR: 35). Using Beers criteria for the assessment of prescription of potentially inappropriate medications, 106 (30.3%) of all patients had at least one inappropriate medication prescribed with a total of one hundred and twenty six cases recorded. Screening for PIM using the STOPP criteria, we found 55 (15.7%) of the study participants with at least one potential encounter. Female sex, number of prescribed medications and co-morbidities were positively associated with prescription of a PIM using both tools. CONCLUSION: Prescription of PIM is highly prevalent among elderly Nigerian patients. There is a need for continuing education of prescribers on rational prescribing in the elderly using some of the screening tools.

Effects of stigmatization/discrimination on antiretroviral therapy adherence among HIV-infected patients in a rural tertiary medical center in Nigeria.

INTRODUCTION: Stigmatization and discrimination impact negatively on interventions and act as barriers to all HIV/AIDS activities. This study assessed the relationship between stigmatization and discrimination and adherence to antiretroviral therapy (ART) among HIV-infected patients attending the Federal Medical Centre, Ido-Ekiti, Nigeria. METHODS: A cross-sectional study was carried out among respondents selected by systematic random sampling. Structured, interviewer-administered questionnaires were used to collect data subsequently analyzed with SPSS 16. RESULTS: A total of 100 respondents comprising 61 (61.0%) female participants were interviewed. A large proportion, 92.0%, had a low level of stigmatization. In all, 88 (88.0%) had a good level of antiretroviral adherence using a threshold of >95%. More people living with HIV/AIDS (PLWHAs) with low stigmatization and discrimination had good adherence to ART (P < .001). CONCLUSION: The PLWHAs with low levels of stigmatization and discrimination are more likely to adhere to ART than those with high levels. Counseling services and health education on adherence should be a strong component of all PLWHA care.

Chloroquine-induced Acute Dystonic Reactions after a Standard Therapeutic Dose for Uncomplicated Malaria.

Acute dystonic reactions (ADR) are extrapyramidal effects that usually occur after the initiation of a wide variety of drugs or triggering factors besides neuroleptics. We report the case of a 54-year-old man who was admitted with an approximately 10-hour history of muscle twitching around the eyes, face and neck after he took the first dose of oral chloroquine phosphate (1 g [600 mg base]) prescribed for uncomplicated malaria. He was given intravenous diazepam (10 mg statum) followed by 10 mg of oral diazepam 3 times a day. The symptoms improved within 30 minutes of treatment, and he was discharged 14 hours later after a complete recovery.

Prescription pattern and prevalence of potentially inappropriate medications among elderly patients in a Nigerian rural tertiary hospital.

INTRODUCTION: Polypharmacy and inappropriate prescriptions are prominent prescribing issues with elderly patients. Beers criteria and other guidelines have been developed to assist in the reduction of potentially inappropriate medications prescribed to elderly patients. The objectives of this study were to assess the prescribing pattern for elderly Nigerian outpatients and estimate the prevalence of potentially inappropriate medications among them using the Beers criteria. METHODOLOGY: This was a prospective cross-sectional study of elderly patients (65 years and above) who were attending the general outpatients clinic of a rural Nigerian hospital. For the drug utilization aspect of the study, drug-use indicators were assessed using established World Health Organization guidelines, while the Beers criteria was used to screen for potentially inappropriate medications. RESULT: The medical records of 220 patients aged 65 years and above were utilized for the study. A total of 837 drugs were prescribed for the patients, giving an average of 3.8 ± 1.3 drugs per person. Antihypertensive drugs accounted for 30.6% of the prescriptions, followed by multivitamins/food supplements (11.5%) and analgesics (10.8%). A review of the prescribed medications using the 2012 Updated Beers Criteria by the American Geriatric Society identified 56 patients with at least one potentially inappropriate medication prescribed giving a rate of 25.5%. The drug groups identified were nonsteroidal anti-inflammatory drugs, antihistamines, and amitriptyline. CONCLUSION: Polypharmacy and prescription of potentially inappropriate medications are major therapeutic issues in Nigeria. There is a need for prescriber training and retraining with emphasis on the geriatric population.