An Assessment of Glycaemic Control and Modes of Health Financing among Type 2 Diabetic Patients Attending a Teaching Hospital in South-western Nigeria.

BACKGROUND: Type 2 diabetes mellitus can be a major drain on resources due to lifelong treatment and risk of catastrophic expenditure from treatment of complications. The prevalence has been projected to rise to alarming levels in developing countries. This study aimed to assess the levels of, and associations between good glycaemic control among patients with type 2 diabetes and their modes of financing healthcare. METHODS: In this hospital based descriptive cross-sectional study, 260 patients being managed for type 2 diabetes at the outpatient clinics of Lagos University Teaching Hospital, Lagos were recruited by systematic random sampling method. All participants received a HBA1C test to assess glycaemic control and a composite interviewer administered questionnaire adapted from the MMAS-8 and diabetes care profile to assess medication adherence, modes of financing and other factors related to disease management. RESULTS: Of the 260 study participants, 34.62% (90) had good glycaemic control. In the mode of health care financing only 15% (39) paid by health insurance (NHIS), while 85% of the respondents' payment was by out-of-pocket (OOP) payment. About half of these OOP payments were made by family, friends and others (in this study, a proxy for informal means of pooling finances). Significant associations were found between glycaemic control and adherence (2 13.93, p=0.001), glycaemic control and mode of payment (2 15.30, p=0.0000) and also adherence and mode of payment (2 16.59, p =0.002). CONCLUSION: In this study, only about a third of patients with type 2 diabetes achieved good glycaemic control, most patients used OOP financing and patients with OOP financing had poorer adherence and poorer glycaemic control. There is a need to scale up health insurance to improve health outcomes in diabetes management and protect people in developing countries from the burden of health care costs of chronic diseases like type 2 diabetes.

Blood Pressure Levels and Associated Lifestyles Practices among Spouses of Patients with Hypertension Attending the General Outpatient Clinic of a Teaching Hospital in Lagos, Nigeria.

BACKGROUND: Hypertension is the commonest cardiovascular risk factor in the world. In Nigeria there have been rapid changes to a more western lifestyle and this is strongly associated with hypertension. Many spouses share similar lifestyle practices. The aim was to examine the association between elevated blood pressure and lifestyle practices among spouses of hypertensive patients. METHODS: In a hospital based cross-sectional descriptive study at the General Outpatient Clinic of Lagos University Teaching Hospital, two hundred and thirty spouses of hypertensive patients were recruited by systematic sampling. An interviewer administered questionnaire adapted from WHO STEP instrument. Blood pressure was measured with a standardized mercury sphygmomanometer. RESULTS: The mean age of respondents was 52.3 ± 9.73 years. The mean systolic and diastolic blood pressures were 128.45 ± 19.47 mmHg and 82.68 ± 11.71 mmHg respectively. The proportion of respondents who had elevated systolic or diastolic blood pressure was 35.2 %. Proportion of current smokers was 3.9% and 3.5 % of respondents had excessive consumption of alcohol in the preceding seven days. Up to 43.9% of respondents had taken alcoholic beverage within the previous 12 months. About half (45.7%) of respondents engaged in moderate physical activity that lasted for at least 150 minutes per week. There was a statistically significant association between, the following factors and elevated systolic blood pressure among respondents; alcohol consumption within the past 12 months (c2= 6.738, p= 0.009); higher frequency of extra salt consumption (c2 = 4.816, p = 0.028); and red meat intake > 14times/week (c2 = 10.673, p = 0.014), with tobacco smoking (c2=6.202, p=0.037) and higher frequency of extra salt (c2 = 7.416, p=0.006) being significantly associated with elevated diastolic blood pressure. On the other hand, daily fruit intake (c2= 4.158, p=0.042) and vigorous physical activity >75min (c2=5.403, p=0.017)were significantly associated with non-elevated blood pressure among respondents. CONCLUSION: From this study, it can be concluded that more than one third of spouses of patients with hypertension are likely to have elevated blood pressure. It can also be concluded that elevated blood pressure among spouses of patients with hypertension is mostly associatedwithlack of vigorous physical activity >75min per week, recent consumption of alcohol, current smoking status, lack of daily fruit intake, higher salt consumption (addition of extra salt to served meal) and increased red meat consumption. Thus, this study has shown the importance of spousal case finding for both hypertension and adverse lifestyle practices, as a vital component of comprehensive care offered by family physicians caring for patients with hypertension.