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.

The prevalence of early childhood caries and its associated risk factors among preschool children referred to a tertiary care institution.

OBJECTIVE: The aim was to determine the prevalence of early childhood caries (ECC) and its association with infant feeding and oral health-related behavior among preschool children aged 6-71 months in Lagos. MATERIALS AND METHODS: This was a descriptive cross-sectional study in which 302 children aged 6-71 months were selected from four pediatric outpatient clinics in Lagos, Nigeria. A structured questionnaire was used to obtain information regarding oral hygiene practices, dietary habits, breast and bottle feeding, birth weight of child and socioeconomic status of the family, from mothers of the children. The status of dental caries was recorded according to the World Health Organization criteria. RESULTS: The prevalence of ECC among 302 children aged 6-71 months was 21.2% while the mean deft was 0.735. Multivariate logistic regression analysis showed the correlation of ECC with the associated risk factors. ECC was significantly higher in children who were bottle-fed at night. Method of tooth cleaning other than using fluoridated toothpaste significantly increased the prevalence of ECC. Breastfeeding for duration of 3-6 months showed significantly lesser caries prevalence. Caries significantly increased with age. CONCLUSION: Early childhood caries is a multifactorial disease in which prolonged duration of breastfeeding, nocturnal bottle feeding, and use of cleaning methods other than fluoridated toothpaste are risk factors for ECC. Oral health promotion programs should be targeted at mothers, pediatricians, nurses, caretakers at day care centers and primary care health workers.

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.

Orthodox versus unorthodox care: A qualitative study on where rural women seek healthcare during pregnancy and childbirth in Southwest, Nigeria.

INTRODUCTION: Utilization of orthodox health facilities for maternal health services is determined by factors operating at the individual, household, community and state level. The prevalence of small family norm is one of the identified variables operating within the community which influences the decision of where to access care (orthodox/traditional). The objective of the study was to determine the use of orthodox versus unorthodox maternity healthcare and determinants among rural women in southwest Nigeria. METHODS: A qualitative study was done and involved three focus group discussions. A semi-structured interview guide was used to collect information from women of reproductive age group within a rural Local Government Area in Lagos state. RESULTS: Most of the women access some form of healthcare during pregnancy, orthodox, unorthodox or both. Those who patronize both services concurrently do so to benefit from the two as each has some unique features such as herbal concoctions for traditional, ultrasound and immunization of babies for orthodox. Traditional belief exerts a strong influence on decision of where to access maternal healthcare services. Actual place of delivery is determined by individual and household factors including financial resources. CONCLUSION: Rural women utilize one or both orthodox and unorthodox maternal health services for different reasons. Ward Development Committees should be strengthened so as to reach the communities, educate and convince women to dispel myths which limit their use of orthodox care. Training and monitoring of Traditional Birth Attendants (TBAs) are vital to eliminate harmful practices. We also recommend improved financial access to orthodox healthcare.

Blood donation practices and willingness to donate among residents of an urban slum in Lagos Nigeria.

AIM AND OBJECTIVES: This study was carried out to assess the blood donation practices and willingness to donate among residents of an urban slum. MATERIAL AND METHODS: Cross sectional descriptive study design with a qualitative and quantitative component. Multistage sampling was used to select 400 respondents for the questionnaire interview while three FGD sessions were conducted guide among three groups of participants namely youths, men and women. The information collected was analyzed manually (FGD) and with Epi info version 3.5.3. RESULTS: Majority of the questionnaire respondents were female, married, traders, had at least secondary school education, with mean age of 37.6 years. Only 12.0% had donated in the past, the main reason given by non donors was that they had never been asked to donate; this was also a key finding in the FGD. Willingness to donate was positively associated with being a male, single and Christian, age was a significant predictor of previous donation while more of the previous donors were still willing to donate, more for family/friends (p=0.036) than voluntarily (p=0.001) this view was supported by the participants at the FGD. CONCLUSION: Members of this urban slum had poor practice of blood donation,had positive attitude and were willing to donate, there is need to mobilise and organise outreach blood donation programs to convert attitude into actual practice.

Non-uptake of facility-based maternity services in an inner-city community in Lagos, Nigeria: an observational study.

Scaling-up of skilled attendants and facility-based services is necessary for improving maternal and child care in developing countries but their effectiveness is crucially influenced by the uptake of such services. This study set out to establish the pattern and uptake of maternity services and associated factors against the backdrop of rapid urbanization in Nigeria. A cross-sectional study of socio-demographic and obstetric characteristics of mothers attending the Bacille Calmette-Guérin (BCG) immunization clinics in inner-city Lagos was conducted from July 2005 to December 2007, and their association with non-hospital delivery and use of unskilled attendants was determined by multiple logistic regression analyses. Of the 6465 participants, over half (51.4%) delivered outside hospital facilities and 81.8% of this group had no skilled attendants at delivery. Non-hospital delivery or the presence of unskilled attendants at delivery was associated with teenage mothers, Muslim religion, low or middle social class and use of herbal drugs in pregnancy. Additionally, non-hospital delivery was associated with ethnicity (Yoruba tribe), lack of tertiary education or full-time employment, accommodation with shared sanitation facilities and multiparity. The results suggest that availability of and access/proximity to hospital facilities or skilled attendants is no guarantee of uptake of maternity services. Efforts aimed at improving maternal and child health in developing countries should take cognisance of the socio-demographic and cultural underpinnings of maternal health-seeking behaviour of urban mothers beyond the provision of facility-based services or strengthening of the existing health care systems.

Toluene Diisocyanate-Linked Ocupational Airflow Obstruction and Peak Expiratory Flow Rate Patterns among Foam Makers

This study looked at the prevalence of respiratory symptoms and airflow obstruction; and peak expiratory flow rate (PEFR) variation between production workers and control workers (both inside and outside work; linked to the foam-making industry at Onitsha; south -east Nigeria. A cross-sectional case control study was conducted among 199 randomly selected workers from five major foam companies.Subjects were grouped into exposed (production workers) and control; and a modified structured four-part Guidelines for Health Surveillance for Isocyanates questionnaire was administered. The workers had their PEFR values individually assessed during work on Friday and before resumption of work the following Monday morning for a period of 6 months. A total of 199 subjects were recruited (129 production workers; 70 control workers). There was a higher proportion of respiratory symptoms among the exposed group (53) compared with the controls (34) (p0.02). It was concluded that airflow obstruction and respiratory symptoms are common among workers in foam industries exposed to toluene diisocyanate

Effect of Use of Insecticide Treated Nets on Birth Outcomes Among Primips in a Peri-Urban Slum Settlement in South-East; Nigeria

Introduction : Each year in sub-Saharan Africa; where 80 to 90 of the world's malaria cases occur; approximately 19 to 24 million women are at risk for malaria and its adverse consequences during pregnancy. The major impact of malaria during pregnancy in these regions is caused by persistent or recurrent; predominantly low-grade; sometimes sub-patent; parasitaemia. In Nigeria; malaria has severe negative effects on maternal health and birth outcomes; resulting in maternal anaemia; a high incidence of miscarriages and low birth weight. Primigravidae and secundigravidae are most at risk. Resistance to first-line antimalarials has increased in sub-Saharan Africa; and the available arsenal of alternative tools for malaria control in pregnancy is very limited. One of the most promising of these tools is insecticide-treated bed nets (ITNs); which have been shown to reduce the number of infective mosquito bites by 70 to 90 in a variety of ecologic settings. In Nigeria; the current use of ITNs by the at-risk groups; pregnant women and children under five years; is just 1; according to the latest report of the Nigeria Demographic and Health Survey (NDHS).Aim : This study aimed at examining the effects of the use of ITNs on pregnancy outcomes among 208 primigravidae. Methodology : The study design was an analytical case control. One hundred and four subjects; the intervention group; received ITNs between August 2003 and January 2004The other 104 subjects were the control. Data were obtained using the new World Health Organization antenatal care classifying form and the basic component checklist; and a self-structured; 30-item pre-tested questionnaire. The Apgar scores of the babies and their birth weights were observed and recorded for both the intervention and the control groups.Results : The results showed that 83 of babies of mothers in the intervention group had a good condition at birth; while 87 of babies of mothers in the control group had a good condition at birth (p larger than 0.07; X2=1.69). A small increase in mean birth weight (0.001kg) of the babies of mothers in the intervention group was observed over those of mothers in the control group (p larger than 0.90). This showed that there were no significant beneficial impacts of the use of ITNs on foetal condition at birth; mean birth weight and low birth weight.Conclusion : The use of ITNs by primigravidae in Okpoko; a peri-urban slum in south-eastern Nigeria; showed no significant impact on pregnancy outcome

Perceptions and practices of private medical practitioners to adolescent reproductive health in Lagos State, Nigeria.

INTRODUCTION AND OBJECTIVES: Adolescent sexual and reproductive ill health is a major global public health issue, contributing to high levels of morbidity and mortality in adolescents. Although adolescents are known to have low levels of doctor consultations, private medical practitioners remain the preferred health care providers. This study was carried out to document the attitudes and experiences of private medical practitioners to adolescent reproductive health issues and to assess the factors that may influence their attitudes. METHODS: Information was obtained from a random sample of 187 out of 352 (53% ) registered private medical practitioners in 5 of the 20 Local Government Areas in Lagos State using a self-administered structured questionnaire. RESULTS: Sixty-two per cent of the doctors claimed they saw adolescents regularly, mainly for the treatment of sexually transmitted infections (STIs). Many (86% ) believed that adolescents should use contraception and suggested that parents, teachers and health workers provide sexuality information to adolescents. Sixty one percent of the practitioners believed that abortion should be legalised, though with restrictions. Many of them admitted to providing post abortion care to adolescents. The religious affiliation of the private medical practitioners influenced their perception and practices. CONCLUSION AND RECOMMENDATIONS: Improving the reproductive health care of adolescents is key to improving the world's future economic and social well being. It is recommended that appropriate sexuality education be made widely available to adolescents. In addition, private medical practitioners should strengthen their skills and be more actively involved in the care of adolescents by making their facilities more adolescent friendly.

Oil doom and AIDS boom in the Niger Delta Region of Nigeria.

CONTEXT: There has been a steady rise in Nigeria's HIV/AIDS burden since the first sero-prevalence survey in 1991. Nigeria's economy is mainly dependent on oil that comes from the Niger Delta Region. The majority of the people of the Niger delta region depend on fishing and farming for livelihood. Years of oil exploration activities with frequent oil spillages have led to severe environmental degradation with resultant destruction of farmlands and aquatic flora and fauna. The situation of the people of Niger Delta is characterised by poverty, high fertility and disease. ISSUE: Oil has become, to the people of the Niger Delta region a doom that has contributed in no small measure to the AIDS boom in the region. The relationship between such a burden and poverty has been forged by years of official neglect, and the presence of foreign workers. In addition, young Nigerians are drawn to the Niger Delta region by the oil economy, searching for non-existent jobs. Within Nigeria, the states of the Niger Delta region bear the burden of the spread of HIV/AIDS, and the region's poverty amidst plenty, has a negative impact on the population. LESSONS: The article concludes that the HIV/AIDS burden of the region deserves urgent and special attention because it has far-reaching implications, not only for control efforts in Nigeria, but also for the rest of the world, as nationals of various countries find employment in its oil fields. A number of recommendations are made.

The examination of the jugular venous pressure (JVP): variation of technique amongst Nigerian resident doctors.

Resident doctors in Internal Medicine Faculty and General Medical Practice from accredited residency programmes from all over Nigeria were surveyed to investigate the existence of variation in the technique of clinical examination. Using a 10 item self administered questionnaire, the doctors were required to answer questions to test knowledge and skill of examining the jugular venous pressure. Data from 70 Internal Medicine (IMR) and 30 General Medical Practice Residents (GMP) were analysed. For both groups, years of post medical graduation and period spent in residency programme were comparable. On methodology of examination of JVP, there was significant inter- and intra group variation. Sixty per cent (60%) of IMR and only 10% of family practice doctors will use the internal jugular vein alone for assessment, whilst a comparable proportion (30% of IMR and 25% of GMP) will use both internal and external jugular veins. Whilst the sternal angle was the choice of reference point in the majority (87% of IMR versus 80% of GMP), the patient placement angle of 45 degrees was 93% for IMR and 100% for GMP. No respondent chose 60 degrees. Only 40% of both IMR and GMP will always use confirmatory maneuvers, especially the hepatojugular reflux. No GMP doctor and 25% of internal medicine will sometimes use posture and respiratory maneuvers to enhance their clinical decisions. Only 33% IMR and 40% of GMP indicated a correct value and/or unit of measurement for normal jugular venous pressure (JVP). Comparing the internal medicine and General Medical Practice Residents, there was marked inter- and intra-group variation, with more variation noted amongst the IMR. Most importantly, less than 50% of residents knew the correct value of an abnormal JVP. This variability of methodology and poor knowledge will impact on performance in the residency programme, patient care and medical education.