Assessment of workhour feeding practices, healthy behaviour score and body mass index of physicians in Northern Nigeria: a cross-sectional multi-centre study.

Background: The increasing prevalence of obesity and overweight among health workers calls for an appraisal of their lifestyle. This study assessed medical practitioners' workhour feeding and lifestyle practices and explored the relationship between these practices and their body mass index (BMI). Methods: The survey involved 321 medical practitioners selected from 9 northern Nigeria hospitals in 2021. Data collected included biodata, medication history, workhour feeding characteristics, lifestyle behaviours, blood pressure, height, and weight measurements. Data were analyzed using Epi info software (version 7). Results: Most respondents were male (70.7%). Their mean age was 38 ± 7.4 years. During their last workhours, 84.1% had lunch, and 46.4% took sugary drinks. Usually, 41.7% source their lunch from the hospital canteen, and 18.7% patronize their canteen at least weekly. Most reported healthy behaviour towards alcohol consumption (99.7%), fruit and vegetable consumption (54.8%) and smoking (98.4%). However, only 22.4% were physically active. Their mean healthy behaviour score and BMI were 2.8 ± 0.7 and 26.1 ± 4.6 kg/m2, respectively. The obesity and overweight rates were 18.4% and 37.7%, respectively. Their source of lunch during workhours, age, sex, years of practice, employment duration, marital status, job category, systolic blood pressure, anti-hypertensive, and antidiabetic medication use were significantly associated with mean BMI. However, only antihypertensive medication use, being married, inadequate fruit/vegetable consumption and workhour sugary drinks consumption predicted obesity. The predictors of overweight/obese were years of practice (< 10 y) and use of antihypertensive medications. Conclusions: Obesity and overweight rates were high. Most were physically inactive. Workhour sugary drink consumption predicted obesity. Effective workplace and community interventions to improve practitioners' lifestyle behaviour and curtail obesity and overweight are needed.

Influence of prior internist encounter on glycaemic control among patients with type 2 diabetes mellitus at a family practice setting in Nigeria.

Background: The huge global diabetes burden and the paucity of diabetes specialists make primary care physicians important stakeholders in controlling diabetes. Hence, we examined the predictors of glycaemic control among primary care patients with type 2 diabetes mellitus (T2DM), highlighting the influence of prior internist encounters during the preceding year on glycaemic control. Methods: This questionnaire-based cross-sectional study involved 276 T2DM patients systematically recruited from attendees of a general outpatient clinic (GOPC) in Kano, Nigeria. Data regarding their sociodemographic, clinical and internist encounter and GOPC visit characteristics were collected. Data were subjected to descriptive and inferential statistical analysis. Results: Most participants (56.5%) were females; their mean age was 57.7 ± 9.6 years, mean glycated haemoglobin level was 7.3 ± 1.9%. Age, educational level, ethnicity, insurance status, current blood pressure (BP), treatment type, medication adherence, awareness of the importance of diet in DM control, specialist diabetic clinic visited, number of GOPC visits and prior encounter with an internist in the preceding year were associated with glycaemic control after bivariate analysis (P < 0.05). On multivariate regression, low education, retirees, being self-employed, uninsured, overweight, having optimal BP, using metformin alone, sulphonylurea-metformin and insulin-based treatments and prior encounter with the internist in the preceding year were predictors of optimal glycaemic control. Conclusion: There are multiple predictors of glycaemic control in this setting. These predictors should be considered in glycaemic control risk stratification towards quality individualised care, which includes establishing referral protocols to available specialists. Regular training of primary care physicians on diabetes care is also required.

Snakebite knowledge assessment and training of healthcare professionals in Asia, Africa, and the Middle East: A review.

Snakebite envenoming (SBE) is a common neglected tropical disease in rural communities of Asia, Africa and Latin America. Among the several challenges besetting the control of SBE is inadequate access to high-quality care by snakebite victims, partly contributed by inadequate knowledge of SBE among healthcare professionals (HCPs). This narrative review examined the existing literature on the knowledge of snakebites among HCPs, the factors associated with their knowledge of snakebites and their training needs. Data on the knowledge of healthcare professionals regarding snakebites appeared scanty and were predominantly from studies done in Asia, Africa, and the Middle East. We found that the proportion of health workers with adequate knowledge of local medically important snakes could be as low as 20.2% in some settings in India, while as much as three-quarters of health workers still recommend tourniquets and Blackstone as first aid in some settings in India and Rwanda, respectively. In addition, the mean knowledge score of local snake-induced clinical syndromes could be as low as 46.2% in some settings in Ghana, while 52.7% of tertiary hospital doctors in northern Nigeria recommend antivenom in all snakebite cases. Similarly, 23% of Bhutan health workers have adequate overall knowledge of snakebite management. Furthermore, several sociodemographic characteristics of the HCPs (such as increasing age, years of experience, work setting, medical specialty, health profession and previous involvement in snakebite management) are associated with adequate snakebite knowledge. Moreover, most studies have consistently reported a lack of training on snakebites as a challenge. Therefore, the knowledge gaps identified could be incorporated into training programs and regional policies on SBE treatment protocols.

Association between Family Functionality, Sociodemographic Factors, and Severity of Depression in Women with Infertility Attending a Gynecology Clinic in Northwest Nigeria.

Background Depression is a common psychological disorder in women with infertility, which causes significant morbidity and mortality. Little attention is currently given to depression by health care providers who manage infertility, and there is a scarcity of studies on depression among women with infertility in northern Nigeria. Objective This study aimed at assessing the association between family functionality, sociodemographic factors, and depression severity in women with infertility attending a gynecology clinic in northwest Nigeria. Methods This was a cross-sectional study involving 415 females systematically selected from women with infertility attending a gynecology clinic in a Nigerian hospital. They were interviewed using Beck's Depression Inventory and Family APGAR (Adaptability, Partnership, Growth, Affection, Resolve) questionnaires over 12 weeks. Data regarding participants' sociodemographic and infertility characteristics were also collected. The association between categorical variables was assessed using the chi-square or Fisher's exact test. The determinants of depression severity were assessed using logistic regression analysis. A p -value of < 0.05 was considered significant. Results The mean age of respondents was 30.9 ± 6.6 years; the prevalence of depression was 44.6% (32.5% were of mild severity). Most families (73.5%) were highly functional. Association between family functionality and depression severity was not statistically significant (chi-square =5.143, p = 0.259). Respondents' religion (chi-square = 10.813, p = 0.029), education (chi-square = 36.835, p = 0.001), and monthly income (chi-square = 9.261, p = 0.010) were associated with depression severity. Being a Muslim (odds ratio [OR] = 2.9, 95% confidence interval [CI] = 1.8-5.6, p = 0.001) and having formal education (OR = 10.2, 95% CI = 4.7-16.5, p = 0.001) were determinants of depression severity. Conclusion The prevalence of depression was high among the respondents. Although no association was found between family functionality and depression severity, respondents who are Muslims or had formal education were at increased risk of depression. Therefore, a high index of suspicion for depression and holistic care is required to manage women with infertility.

Knowledge, attitude, and practices of patients and caregivers attending a Northern Nigerian family medicine clinic regarding the use of face mask during COVID-19 pandemic: a hospital-based cross-sectional study.

Introduction: facemask use is well recognized as an effective public health strategy for preventing COVID-19. However, facemask can only provide enough protection if people recognize its importance and learn how to use it properly. The objective of the study was to assess the knowledge, attitudes, and practices (KAP) of patients or caregivers regarding the use of facemasks as a COVID-19 preventive measure and identifies the factors associated with its practice. Methods: a cross-sectional study where 480 patients or caregivers attending the Family Medicine Clinic were systematically selected over four weeks. A self-administered questionnaire was used to collect data on KAP regarding facemasks use. Student t-test and analysis of variance (ANOVA) were used to examine the relationship between the socio-demographic characteristics and KAP. Pearson's correlation coefficient was used to determine the relationship between knowledge, attitudes and practices. A p-value ≤ 0.05 was considered statistically significant. Results: about 82% of the respondents knew the correct steps of wearing a facemask, but with low positive attitudes. Further analyses showed that respondents were more likely to wear a facemask at clinics and public places than at home. There was a moderately strong correlation between knowledge and practices but weak correlations between attitude and knowledge, and attitude and practices of facemask use. Conclusion: the study revealed good knowledge and practices but low attitudes towards facemask use. Therefore, public health programmes or interventions on facemask usage as a COVID-19 preventive measure, should address the attitudinal problems and also involve the family and community leaders to enhance compliance.

Prevalence and sociodemographic predictors of perceived family functionality, marital satisfaction and intimate partner violence during the COVID-19 lockdown among married primary healthcare users.

Background: The impact of COVID-19 lockdown on family experiences has not been thoroughly evaluated, given the consequent stressful home environment it reportedly caused that can adversely affect family dynamics. This study examined the prevalence and sociodemographic predictors of perceived family functionality, marital satisfaction and intimate partner violence (IPV) during the lockdown among married healthcare users in a Nigerian primary care setting. Materials and Methods: The study was cross sectional. Data were collected randomly from 432 eligible attendees of a primary care clinic in Kano, Nigeria. Information regarding participants' sociodemographic characteristics, family functioning, marital satisfaction and IPV were measured using a sociodemographic questionnaire, APGAR-, Kansas marital satisfaction- and verbal HITS-scales. Results: Respondents' mean (range) age was 30 (15-70) years; 293 (67.8%) were females. Family dysfunction, marital dissatisfaction and probable IPV were found in 44.2, 56.5 and 50.5% of respondents, respectively. The odds of a functional family were higher among caregiver and female respondents but lower among those aged ≥50 years, students, non-Hausa/Fulani, those with low education and residing outside the Kano metropolis during the lockdown. Marital satisfaction was higher among caregivers and respondents from polygamous families and lower among respondents aged ≥50 years. No studied sociodemographic variable predicted probable IPV. Conclusion: There was a high prevalence of family dysfunction, marital dissatisfaction and probable IPV among the respondents during the lockdown. These findings suggest screening married patients for family dysfunction, marital dissatisfaction and IPV during similar lockdowns for appropriate interventions. The predictor variables could form essential considerations for the screening.

Nutritional status and morbidity patterns of the elderly in a Northwestern Nigerian hospital: A cross-sectional study.

CONTEXT: Nutrition is a significant factor in determining the health of older people because it affects almost all organs and systems, which could lead to varieties of diseases and premature death. AIM: To determine the nutritional status and its association with the morbidity patterns of elderly patients. SETTINGS AND DESIGN: A cross-sectional hospital-based descriptive study involving 348 patients aged 60 years and above who presented at the Family Medicine Clinic. SUBJECTS AND METHODS: Data of the socio-demographic profile, anthropometric measurements and clinical diagnosis were collected. The co-morbidities were classified based on the number, duration and affected organ or system. The nutritional status was assessed with the Mini-Nutritional Assessment tool. STATISTICAL ANALYSIS: Chi-square test and logistic regression analysis were used to determine associations between nutritional status and morbidity patterns of the elderly. The level of significance was set at a P ≤ 0.05. RESULTS: A total of 348 respondents were recruited with 60.9% of females and mean age of 67.83 (standard deviation ± 7.53) years. The prevalence of malnutrition was 25.3% and of risk of malnutrition 56.6%. Furthermore, the prevalence of multi-morbidity was 74.4%. Advanced age (odd ratio = 8.911, confidence interval [CI] = 1.992-39.872, P = 0.004), underweight (OR = 1.167, CI = 0.291-37.846, P < 0.001), lack of formal education, (OR = 1.569, CI = 0.357-0.908, P = 0.018), low monthly income (OR = 1.975, CI = 1.376-2.836, P < 0.001), chronic respiratory diseases (OR = 4.250, CI = 4.025-4.492, P < 0.001) and physical inactivity (OR = 2.466, CI = 1.063-5.722, P = 0.036) were the predictors of malnutrition. Furthermore, the duration of chronic disease for more than 10 years (OR = 1.632, CI = 0.408-0.979, P = 0.040) was significantly associated with at-risk of malnutrition. CONCLUSION: The study revealed advanced age, underweight, low educational status, chronic respiratory diseases and physical inactivity as independent risk factors for malnutrition among the elderly.

Pre-air travel health-seeking behaviour, prevalence of barotitis media, its knowledge and associated factors among recently travelled patients in Kano, Nigeria.

INTRODUCTION: Existing evidence suggests that barotitis media (BM) is common among air travellers, and it has the potential to cause severe discomfort and sometimes permanent hearing and balance deficits. It has not been studied in Nigeria. OBJECTIVE: This study aimed to assess the pre-air travel health-seeking behaviour, prevalence of BM, knowledge of BM and its associated factors among a cohort of outpatients with a history of recent air travel in Kano, Nigeria. MATERIALS AND METHODS: This questionnaire-based survey involved 97 participants systematically and proportionately selected from adult patients or caregivers of children with recent air travel history attending two outpatients clinics over 7 weeks. Information on biodata, pre-air travel advice-seeking behaviours, air travel experience and BM knowledge were obtained. Data were analysed using the descriptive statistical methods, Chi-square or Fisher's exact tests and odds ratio (OR). RESULTS: Most participants were male (54.6%) with tertiary education (87.6%); the prevalence of BM was 44.3% (43/97). Only 2.1% (2/97) had ever sought pre-air travel advice from a doctor; 83.5% (81/97) had heard of BM before; 42% had adequate knowledge of BM. Employment status (Fisher's exact, P = 0.001), clinic at recruitment (Fisher's exact, P = 0.00008), duration of last flight (Fisher's exact, P = 0.0001) and persistent ear-pain after landing (Fisher's exact, P = 0.001) were significantly associated with participants' knowledge of BM. Persistent ear-pain after landing was the predictor of BM knowledge (OR = 0.04, 95% confidence interval [0.002-0.67], P = 0.025). CONCLUSION: The BM knowledge level of this cohort suggests the need for further studies to ascertain the complete picture and justify improved pretravel education of air travellers in our setting.

Awareness, Knowledge, and Perception of the National Health Insurance Scheme among National Youth Service Corp Members in Kano, Nigeria.

BACKGROUND: The lofty objectives of the National Youth Service Corp (NYSC) are not only predicated on healthy graduates of tertiary institutions but also graduates who are confident in making informed health-related decisions. Therefore, Corp members' awareness, knowledge, and perception of the National Health Insurance Scheme (NHIS) and its programs become imperative. MATERIALS AND METHODS: This was a cross-sectional study involving 203 participants selected by convenience sampling technique from NYSC members during Orientation Camp in June 2019. A self-administered questionnaire was used to collect data regarding their sociodemographics, awareness, knowledge, and perception about the NHIS. RESULTS: The mean age of respondents was 25.8 ± 2.3 years; they were predominantly males (136 [67.0%]) with university degrees 131 (64.5%); 200 (98.5%) were aware of the NHIS and its programs. Although 161 (80.5%) respondents had at least average knowledge of the NHIS, only 97 (48.5%) had adequate knowledge. One hundred and fifty-eight (79.0%) respondents benefited from the Tertiary Institutions Social Health Insurance Programme (TISHIP) as students; 114 (57.0%) viewed TISHIP as a good program; however, 194 (97.0%) felt that the NHIS services should be extended to NYSC members, while 188 (94.0%) were willing to participate in the scheme if its services were extended them. CONCLUSION: Although awareness level was high, adequate knowledge of the NHIS was low and their perception about TISHIP is unimpressive; most were willing to participate in the NHIS. Current mass NHIS-programs education campaigns and services offered by NHIS-accredited health-care facilities need improvement; fast-tracking of processes necessary for the extension of NHIS services to NYSC members is required.

Impact of COVID-19 pandemic on primary care research in a resource-limited setting: a commentary.

The COVID-19 pandemic has impacted on several aspects of human existence including primary care research activities in resource-limited settings. Opportunities exist for initiating multi-disciplinary collaborative research teams that may examine current controversial areas of the disease such as prevention, diagnosis and treatment; experiences of stakeholders like COVID-19 survivors and frontline health workers; and individuals and community experiences during lockdowns. Challenges associated with initiating new studies and/or sustaining old ones and publication of research outcomes may need to be curtailed through alternative strategies and support from stakeholders.

Perception of Factors Influencing Primary Health-Care Facility Choice Among National Health Insurance Enrollees of a Northwest Nigerian Hospital.

BACKGROUND: The National Health Insurance Scheme (NHIS) of Nigeria was designed to eliminate known cultural, physical, and resource-related barriers to quality health-care access. Although choice of primary health-care facility (PHF) remains in the domain of the scheme enrollees, little is known about factors influencing their choice. Hence, the study of the perception of factors influencing PHF choice among NHIS enrollees of a northwest Nigerian hospital becomes imperative. METHODS: This was a cross-sectional study of 284 principal enrollees randomly selected from patients attending the NHIS clinic of Aminu Kano Teaching Hospital, Kano, Nigeria, using a designed, pretested, investigator-administered questionnaire. Their sociodemographics and factors influencing their choice of the clinic were assessed. RESULTS: Respondents' mean age was 40.9 ± 9.0 years and they were predominantly males (83.1%) with tertiary education. Median distance between their homes and PHF was 7.6 ± 12.5 km. Most respondents were aware of other accredited PHFs in the city and believed it was their right to choose a PHF. Among the various factors influencing their choice of index PHF were better functioning equipment (83.5% of respondents), more specialists/trained health workers (78.5%), ease in receiving specialist care (69.4%), and better overall quality of care (78.9%). CONCLUSION: There are multiple factors associated with enrollee choice of PHF in this study. The NHIS enrollees value the presence of functioning equipment/facilities, ease in receiving specialist care, and overall high quality of care in their choice of PHF. Improving enrollee enrollment at accredited PHF may require addressing these factors.

Trends and correlates of patient satisfaction with services under the National Health Insurance Scheme of Nigeria: A review

Background: In spite of over a decade of operations, the National Health Insurance Scheme (NHIS) of Nigeria has continuously been criticized for its quality of services. Healthcare consumer satisfaction surveys (an important measure of service quality worldwide) in this domain have presented differing accounts of satisfaction with the services of the NHIS from their vantage perspectives. This narrative review aimed at studying the preliminary trends in the utilization of and patient satisfaction with the NHIS services. The correlates of patient satisfaction were also studied. Materials and Methods: We searched local literature whose full texts were accessible using predominantly Google Scholar. Results: We found progressive improvement in scheme enrolment, service utilization, and above-average overall satisfaction scores (i.e., >50% of respondents were satisfied) from most studies. Overall satisfaction scores/ratings were associated patients' level of education, knowledge of the scheme, years of enrolment, facility cleanliness, consultation time, pharmaceutical services, ease in accessing medical records and laboratory results, health worker availability, health worker friendliness, and responsiveness to patients' requests. Conclusion: The observed trajectory in service utilization, satisfaction scores, and their correlates may be useful for strategic planning to improve NHIS services in the country toward universal health coverage

Assessment of Sleep Quality among Medical Doctors in a Tertiary Hospital in a Semi-Rural Setting.

INTRODUCTION: Sleep is an integral part of human physiology; therefore, disorders of sleep may result in significant derangement in human functionality. Sleep medicine has received little attention in Nigeria. Against this backdrop, this survey seeks to evaluate the quality of sleep among doctors. METHODOLOGY: This was a cross-sectional descriptive study involving 59 doctors working with Federal Medical Centre Birnin Kebbi, Kebbi State, Nigeria; it was done between August 2017 and December 2017. Purposive sampling method was adopted. The Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) were adopted. The questionnaire was self-administered. RESULTS: There were 34 (57.6%) males and 25 (42.4%) females. Their age ranged from 20 to 66 years, with a mean of 34.39 ± 8.00. The Epworth score ranged from 8 to 29, with a mean of 16.1 ± 4.4, while the PSQI score ranged from 5 to 19, with a mean of 9.5 ± 2.7. The mean work hour per week was 90.3 ± 36.2 h, and majority of the respondents worked for >80 h and or >24 h consecutively in the preceding week, and most had high ESS scores; however, this observation was not statistically significant (Fisher's exact test = 4.0904, P = 0.213). All respondents were poor sleepers and majority sleep for <7 h in the night. Respondents had worked for 5 years and less; house officers and medical offers had more tendencies for daytime sleepiness. CONCLUSION: All respondents were poor sleepers and also had prolonged work hours per week; there was also heightened daytime sleepiness.

Sleep quality among nurses in a tertiary hospital in North-West Nigeria.

BACKGROUND: Sleep is a necessity; it is nourishing, refreshing and healing. The nursing profession is associated with busy and difficult work schedules, especially the running of shifts which has been associated with cardiovascular and metabolic complications. There is a dearth of local data on sleep disorders, especially among nurses. In this study, we evaluated the quality of sleep and the tendency of daytime sleepiness among nurses. SUBJECTS AND METHODS: This study was cross-sectional in nature involving 100 nurses working with Federal Medical Centre Birnin Kebbi, Kebbi State; the study was carried out between October 2016 and February 2017. The Pittsburg Sleep Quality Index was used to determine poor sleepers; while the Epworth Sleepiness Scale (ESS) was adopted to determine the presence of tendency of daytime sleepiness; 0-7 was considered normal, 8-9 represented average tendency of daytime sleepiness, 10-15 represented excessive daytime sleepiness, while 16-24 represented daytime sleepiness requiring medical intervention. P < 0.05 was set as statistically significant. RESULTS: There were 23 (23%) males and 77 (77%) females, with a male-to-female ratio of 0.3:1. The age range was 18-50 years, with a mean age of 31.4 ± 8.6 years. The ESS score ranged from 0.0-17.0, with a mean score of 7.3 ± 3.5; while the Pittsburg score ranged between 1 and 15, with a mean score of 5.7 ± 2.7, and 61% of the nurses had a poor sleep quality. There was unlikely tendency of excessive sleepiness across all the age groups, though this was not statistically significant (χ2 = 7.258, P = 0.283), and poor sleep quality was most prevalent among the 25-40-year-old group but this observation was also not statistically significant (χ2 = 2.259, df = 2, P = 0.334). CONCLUSION: Poor sleep quality is a problem among nurses, though less tendency to daytime sleepiness was observed in this report.

Assessment of level of satisfaction of national health insurance scheme enrolees with services of an accredited health facility in Northern Nigerian

Introduction: Consumer satisfaction is one of the driving goals of goods and service production. Patient satisfaction surveys, as a means of periodic evaluation of the quality of services offered by the National Health Insurance Scheme (NHIS) accredited facilities, is necessary to ensure that the goals of the scheme are achieved and sustained. Materials and Methods: This was a cross-sectional study of 202 respondents randomly selected from NHIS enrolees attending the Staff Clinic of Aminu Kano Teaching Hospital. It assessed respondents' perceived waiting time, level of satisfaction at the clinic's service units, and overall clinic satisfaction using a modified general practice assessment questionnaire. Results: The mean age of respondents was 36.4 ± 8.1 with a near equal sex ratio. They were predominantly civil servants (79.2%) with tertiary education (75.7%). Most respondents (70.3%) felt waiting time was too long; with 79.7% of those, feeling they spend at least 30 min after arrival at the registration unit to see their doctor. A majority of respondents: 90.1%, 86.8%, 79%, 76.8%, 75.9%, 77.5%, and 80.6% were satisfied with the consultation time, doctors' consultation, medical records, pharmacy, laboratory, accounts, and nursing services, respectively. However, 65.8% were satisfied with the overall clinic services. The perceived sufficiency of the consultation time was associated with overall satisfaction (χ2 = 6.199, P = 0.013). Conclusion: Although 65.8% of respondents were satisfied with the clinic services, the perceived clinic waiting time was dissatisfactory; therefore, further studies on the determinants of overall satisfaction may be required if improvement in the proportion of satisfied service consumers is desired by the clinic managers