Physicians' perception of task sharing with non-physician health care workers in the management of uncomplicated hypertension in Nigeria: A mixed method study.

INTRODUCTION: Task sharing and task shifting (TSTS) in the management of hypertension is an important strategy to reduce the burden of hypertension in low-and middle-income countries like Nigeria where there is shortage of physicians below the World Health Organization's recommendations on doctor-patient ratio. The cooperation of physicians is critical to the success of this strategy. We assessed physicians' perception of TSTS with non-physician health workers in the management of hypertension and sought recommendations to facilitate the implementation of TSTS. MATERIALS AND METHODS: This was an explanatory sequential mixed method study. TSTS perception was assessed quantitatively using a 12-item questionnaire with each item assigned a score on a 5-point Likert scale. The maximum obtainable score was 60 points and those with ≥42 points were classified as having a good perception of TSTS. Twenty physicians were subsequently interviewed for in-depth exploration of their perception of TSTS. RESULTS: A total of 1250 physicians participated in the quantitative aspect of the study. Among the participants, 56.6% had good perception of TSTS in the management of hypertension while about two-thirds (67.5%) agreed that TSTS program in the management of hypertension could be successfully implemented in Nigeria. Male gender (p = 0.019) and working in clinical settings (p = 0.039) were associated with good perception. Twenty physicians participated in the qualitative part of the study. Qualitative analysis showed that TSTS will improve overall care and outcomes of patients with hypertension, reduce physicians' workload, improve their productivity, but may encourage inter-professional rivalry. Wide consultation with stakeholders, adequate monitoring and evaluation will facilitate successful implementation of TSTS in Nigeria. CONCLUSION: This study showed that more than half of the physicians have good perception of TSTS in hypertension management while about two-thirds agreed that it could be successfully implemented in Nigeria. This study provides the needed evidence for increased advocacy for the implementation of TSTS in the management of hypertension in Nigeria. This will consequently result in improved patient care and outcomes and effective utilization of available health care personnel.

Burden of adult neurological diseases in Odeda Area, Southwest Nigeria.

BACKGROUND: Few population-based studies have been conducted to determine the burden of neurological diseases in sub-Saharan Africa. A better understanding of the magnitude and impact of these disorders is pivotal to effective planning and provision of neurological services. METHODS: A cross-sectional survey of 2392 adults in Odeda Local Government Area, Ogun State, Southwest Nigeria was conducted between May and June 2015. Trained non-medical interviewers administered a screening instrument designed to measure the prevalence of neurological diseases and disability, while positive responders were subsequently examined by neurologists. Diagnoses were made clinically according to well-established criteria. RESULTS: The mean age of respondents was 37.2±16.1 years. A total of 842 cases of neurological diseases/disability were diagnosed in 815 individuals (26 individuals with more than one disorder). The all-cause neurological morbidity rate was 352 per 1000, while the crude prevalence rates of common neurological disorders were 304.3 per 1000 for primary headaches, 16.3 per 1000 for tropical ataxic neuropathy, 7.11 per 1000 for stroke, 5.85 per 1000 for essential tremor and 4.18 per 1000 for Parkinson's disease. Neurological years lost due to disability was 2806.18 per 100 000. CONCLUSION: This study provides evidence of a high neurological disease burden within the communities surveyed, which may be representative of Southwest Nigeria. In comparison with findings from previous studies within the same region, this report suggests a persistence of toxiconutritional disorders and postinfectious neurological sequelae on one hand and increased prevalence of non-communicable neurological disorders such as stroke and Parkinson's disease.

Validation of Age Determination with Historical Events in Birnin Kebbi, Northwest Nigeria.

CONTEXT: Birth registration is not universal and remains elusive for some people living in developing countries, such as Nigeria; hence, age determination for healthcare and health-related research is often problematic. AIMS: The aim is to validate the use of a historical events' scale as a tool for estimating the age of Nigerian adults residing in Birnin Kebbi, Northwest Nigeria. SETTINGS AND DESIGN: A cross-sectional survey was conducted in Birnin Kebbi, a metropolitan capital city of Kebbi state, Northwest Nigeria, and included adults aged 18 years and older with a valid document indicating their year of birth. SUBJECTS AND METHODS: Seven historical events comprising major national events were cross-referenced to the individual's personal history to estimate their ages, which were then compared to their documented ages. STATISTICAL ANALYSIS USED: Relationship of the documented and estimated ages was assessed with the Spearman's rank-order correlation and intraclass correlation coefficient (ICC) analyses. RESULTS: A total of 288 subjects (63.2% males) with a mean documented age of 34.5 ± 11.3 (range 18-75) years were surveyed. The mean estimated age was 32.5 ± 11.18 years. Spearman's rank-order correlation analysis showed a statistically strong positive correlation between the actual and estimated ages (0.953, P < 0.001). The ICC between documented and estimated ages was 0.968 (95% confidence interval = 0.959-0.975). CONCLUSIONS: The use of this tool in Nigerian adults provides a reasonably accurate age estimation. Its use in populations and communities with inadequate birth registration may improve the quality of age-related health data in Nigerian adults.