Smartphone Ownership and the Willingness to receive Mobile Health Services among Patients with Hypertension in Nigeria.

BACKGROUND: There are traditional barriers to accessing quality hypertension care in sub-Saharan Africa. Mobile phone technology is increasingly being used to overcome these barriers. This study assessed smartphone ownership and the willingness to receive mobile health services among patients with hypertension in Nigeria. METHODS: Four hundred and twenty-seven (427) patients with hypertension were recruited from two tertiary health institutions in Ekiti State, Nigeria. Questionnaires were fed into the Open Data Kit form, which was used to take data on mobile phone ownership, the willingness to receive and the preferred type of mobile phone-based hypertension health care services. RESULTS: Males were 37.2%. Mean age was 60.6 ± 15.3 years. Of the participants, 48.7% owned smartphones, 21.1% had regular internet subscription on their phones, 94.8% were willing to receive and pay mobile health services. Phone calls (48.0%) and text messages (31.6%) were the most preferred modes of receiving hypertension-related health education. Age category of 45-64 years was the only predictor of willingness to receive mobile health services. CONCLUSION: All our participants owned mobile phones, with 48.7% being smartphones and almost all the participants were willing to receive and pay for mobile health services for prevention, treatment and information on hypertension. Middle age was the only predictor of willingness to receive mobile health, and the most preferred choices were through phone calls and text messages. The above information will guide in the design of favourable mHealth interventions that will be ideal for our study population.

CONTEXTE: Il existe des obstacles traditionnels à l'accès à dessoins de qualité pour l'hypertension en Afrique subsaharienne. La technologie de la téléphonie mobile est de plus en plus utilisée pour surmonter ces obstacles. Cette étude a évalué la possession d'un smartphone et la volonté de recevoir des services de santé mobiles chez les patients souffrant d'hypertension au Nigeria. MÉTHODES: Quatre cent vingt-sept (427) patients hypertendus ont été recrutés dans deux établissements de santé tertiaires de l'État d'Ekiti, au Nigeria. Des questionnaires ont été introduits dans le formulaire Open Data Kit, qui a été utilisé pour recueillir des données sur la possession d'un téléphone mobile, la volonté de recevoir et le type préféré de services de soins de santé contre l'hypertension basés sur le téléphone mobile. RÉSULTATS: Les hommes représentaient 37,2 %. L'âge moyen était de 60,6 ± 15,3 ans. Parmi les participants, 48,7 % possédaient des smartphones, 21,1 % avaient un abonnement Internet régulier sur leurs téléphones, 94,8 % étaient disposés à recevoir et à payer des services de santé mobiles. Les appels téléphoniques (48,0 %) et les SMS (31,6 %) étaient les modes les plus privilégiés pour recevoir une éducation à la santé liée à l'hypertension. La catégorie d'âge de 45 à 64 ans était le seul prédicteur de la volonté de recevoir des services de santé mobiles. CONCLUSION: Tous nos participants possédaient des téléphones portables, 48,7 % étant des smartphones et presque tous les participants étaient disposés à recevoir et à payer des services de santé mobiles pour la prévention, le traitement et l'information sur l'hypertension. L'âge moyen était le seul prédicteur de la volonté de recevoir des soins de santé mobiles, et les choix les plus préférés étaient les appels téléphoniques et les SMS. Les informations cidessus guideront la conception d'interventions mHealth favorables qui seront idéales pour notre population d'étude. Mots clés: Smartphones, Volonté, Santé mobile, Âge moyen, Hypertension, Nigeria.

Knowledge and Prevalence of Heart Disease Risk Factors Among Staff of a Tertiary Institution in Nigeria.

BACKGROUND: Cardiovascular disease is the most common cause of mortality worldwide. Hence, awareness of cardiovascular risk factors is an essential step towards effective reduction of the disease burden. This study determined the knowledge and prevalence of cardiovascular risk factors among Staff of Ekiti State University. Ado-Ekiti, Nigeria. METHODS: A cross-sectional study which comprised of 223 members of staff. RESULTS: There were 103 males (46.2%). Low knowledge of heart disease risk factors was found in 68.6% of the respondents. The prevalence of hypertension, diabetes mellitus, overweight, obesity, physical inactivity was 35.4%, 12.1%, 31.8%, 23.3%, and 83% respectively. Family history of hypertension was a predictor of a high level of knowledge. CONCLUSION: A low level of knowledge and increasing prevalence of cardiovascular risk factors existed among staff of Ekiti State University, Nigeria. Hence, there should be a step-up of awareness campaigns and promotion of healthy lifestyle among this category of people.

Ponseti clubfoot management: changing surgical trends in Nigeria.

BACKGROUND: Congenital clubfoot treatment continues to be controversial particularly in a resource-constrained country. Comparative evaluation of clubfoot surgery with Ponseti methods has not been reported in West Africa. OBJECTIVES: To determine the effects of Ponseti techniques on clubfoot surgery frequency and patterns in Nigeria. METHODS: This was a prospective hospital-based intention-to-treat comparative study of clubfoot managed with Ponseti methods (PCG) and extensive soft tissue surgery (NPCG). The first step was a nonselective double-blind randomization of clubfoot patients into two groups using Excel software in a university teaching hospital setting. The control group was the NPCG patients. The patients' parents gave informed consent, and the medical research and ethics board approved the study protocol. Biodata was gathered, clubfoot patterns were analyzed, Dimeglio-Bensahel scoring was done, the number of casts applied was tallied, and patterns of surgeries were documented. The cost of care, recurrence and outcomes were evaluated. Kruskal-Wallis analysis and Mann-Whitney U technique were used, and an alpha error of < 0.05 at a CI of 95% were taken to be significant. RESULTS: We randomized 153 clubfeet (in 105 clubfoot patients) into two treatment groups. Fifty NPCG patients (36.2%) underwent manipulation and extensive soft tissue surgery and 55 PCG patients (39.9%) were treated with Ponseti methods. Fifty-two patients of the Ponseti group had no form of surgery (94.5% vs. 32%, p<0.000). Extensive soft tissue surgery was indicated in 17 (34.0%) of the NPCG group, representing 8.9% of the total of 191 major orthopaedic surgeries within the study period. Thirty-five patients (70.0%) from the NPCG group required more than six casts compared to thirteen patients (23.6%) of the PCG (p<0.000). The mean care cost was high within the NPCG when compared to the Ponseti group (48% vs. 14.5%, p<0.000). The Ponseti-treated group had fewer treatment complications (p<0.003), a lower recurrence rate (p<0.000) and satisfactory early outcome (p<0.000). CONCLUSION: Major clubfoot surgery was not commonly indicated among patients treated with the Ponseti method. The Ponseti clubfoot technique has reduced total care costs, cast utilization, clubfoot surgery frequency and has also changed the patterns of surgery performed for clubfoot in Nigeria.

Superficial swab cultures in open fracture management: insights from a resource-poor setting.

OBJECTIVE: To identify bacterial isolates from superficial swabs of open fracture wounds at presentation and after infection has been established, and to determine if there are correlations between them. METHOD: Patients who presented with open fractures at the Wesley Guild Hospital, Ilesa, Nigeria between December 2004 and May 2006 were recruited into this prospective study. Superficial wound swabs were taken at presentation and if patient showed evidence of wound infection. RESULTS: Sixty patients had open fractures. The initial bacteria culture of wound swabs taken on the day of presentation was positive in 41 (68.3%) patients. Of these, 19 (46.3%) yielded one bacteria isolate, 17 (41.5%) yielded two and 5 (12.2%) yielded three, making a total of 68 organisms. The most common organism was Staphylococcus aureus. However, as a group, more aerobic Gram-negative rods were isolated than any other bacteria groups. Eleven (18.3%) patients developed wound infections, all of which were polymicrobial. In 10 (90.9%) of these, the microbial isolate of the final wound swab included at least one organism that was present in the initial wound culture. No patient with an initial negative culture went on to develop a wound infection. The mean presentation interval of patients with wounds that became infected was 15.2 ± 7.9 hours (95% CI 9.8-20.5 hours) compared with 2.9 ± 3.1 hours (95% CI 2.0-3.8 hours) for those who did not develop a wound infection (p>0.01). CONCLUSION: In a resource-poor setting, where pre-hospital care is unavailable and patients present late, superficial wound swabs are effective in predicting subsequent organisms that may cause wound infections. CONFLICT OF INTEREST: None.

Microbiology of amputation wound infection in a Nigerian setting.

OBJECTIVE: To identify the microbial pathogens responsible for amputation wound infections, their distribution and antibiotic-sensitivity patterns. METHOD: Consecutive patients who had limb amputations from April 2002 to March 2006 in an Nigerian hospital were recruited into this prospective observational study. The patients' demographic features, indications for amputation, microbiology of stump wound infections and the effects on length of hospital stay were reported. RESULTS: Fifty-seven patients (mean age 34.6 +/- 19.2 years) had amputations in 58 limbs. Trauma leading to limb gangrene following treatment by traditional bone setters was the most common indication for amputation (64%). Approximately 76% of the amputations were in the lower limbs. Wound infection occurred in 48% of the stumps, of which 71% had been amputated because of a trauma injury. Pseudomonas aeruginosa was the most commonly isolated pathogen (40%).There was a very low correlation between the aetiologic bacterial agents and the age of patient, source of referral, indication for amputation and level of amputation. Amputation wound infections significantly prolonged the patients' length of hospital stay (p=0.002). CONCLUSION: Amputation wound infection constitutes a serious morbidity in our practice. Most of the causes are preventable.

Impact of post-abortion counselling in a semi-urban town of Western Nigeria.

This study is designed to evaluate the impact of post-abortion counselling in bringing about changes in sexual behaviour among patients who had treatment for an induced abortion and/or its complication in the department of gynaecology and obstetrics of Wesley Guild Hospital Ilesa and Folasola Specialist Hospital between January 1999 and December 2001. A structured questionnaire designed to evaluate the impact of counselling was administered to 108 patients, who formed part of 238 patients who had undergone induced abortion and who benefitted from the behavioural contract counselling technique. The results showed that the percentage of women using contraception increased from 30 (27.8%) to 53 (49.1%) at the time of interview. The number of subjects with multiple sexual partners fell from about 62 (58%) to 12 (11%). About 24 (45%) found access to contraception difficult. Major factors influencing contraceptive usage and change in behaviour include suffering experienced at the time of termination 26 (49%) and knowledge of contraception 19 (36%). The study advocates post-abortion counselling as a tool to increasing contraceptive usage in women and influencing behavioural changes positively towards health promotives measures.