Translation, Cultural Adaptation and Validation of the Hausa version of the Standardised Mini-Mental State Examination in Northeastern Nigeria.

BACKGROUND: Mini-Mental State Examination (MMSE) is one of the most widely used patient-rated assessment tools but may not be applicable among an overwhelming majority of Nigerians older adults. This is because MMSE was designed and adapted for English speakers, and some of its items are challenging to understand for those with low literacy levels. OBJECTIVES: This study aimed at translating and adapting MMSE into the Hausa language and also evaluates the psychometric properties of the modified Hausa version of MMSE. METHODOLOGY: The MMSE was translated and adapted into Hausa language by an Hausa language expert and focus group of experts and the validity of the adapted Hausa MMSE was evaluated against a gold standard (Diagnostic and Statistical Manual of Mental Disorder V criteria for neurocognitive disorders), among older adults participants (N=100). Descriptive statistics and inferential statistics (Receiver Operating Curve analysis and Cronbach alpha coefficient approach) were employed for data analysis and the alpha level was set at 0.05. RESULTS: The adapted Hausa MMSE has item content validity index of 0.97 and the mean expert proportion relevant rating, across all the experts was 0.99. The adapted Hausa version of MMSE shows 66.7% sensitivity and 84.7% specificity, when the original MMSE cut off point of 24 was used. With ROC analysis, optimal cut-offs derived were 25 and 26 with Area Under Curve of 0.886 (95% CI: 0.816-0.956; Std.Err: 0.036; P=0.000). However, at the optimal cut off of 26, derived using ROC analysis, the modified Hausa MMSE had sensitivity of 93.3% and specificity of 71.8% and the tool internal consistency reliability had alpha value of 0.64. CONCLUSION: Hausa adapted versions of MMSE is a valid cognitive screening tool for Hausa older adult patients although its use for Screening and for monitoring changes warrant considerations for two separate cut- off points.

CONTEXTE: Le mini-examen de l'état mental (MMSE) est l'un des outils d'évaluation évalués par le patient les plus utilisés, mais il n'est peut-être pas applicable chez une écrasante majorité de Nigérians âgés. Cela est dû au fait que le MMSE a été conçu et adapté pour les anglophones et que certains de ses éléments sont difficiles à comprendre pour les personnes ayant un faible niveau d'alphabétisation. OBJECTIFS: Cette étude vise à traduire et à adapter le MMSE en langue haoussa et à évaluer les propriétés psychométriques de la version haoussa modifiée du MMSE. MÉTHODOLOGIE: Le MMSE a été traduit et adapté en langue haoussa par un expert en langue haoussa et un groupe de discussion d'experts, et la validité du MMSE adapté en haoussa a été évaluée par rapport à un étalon-or (critères du Manuel diagnostique et statistique des troubles mentaux V pour les troubles neurocognitifs), parmi des adultes âgés participants (N=100). Des statistiques descriptives et inférentielles (analyse de la courbe d'exploitation du récepteur et approche du coefficient alpha de Cronbach) ont été utilisées pour l'analyse des données et le niveau alpha a été fixé à 0,05. RÉSULTATS: Le MMSE Hausa adapté a un indice de validité de contenu de 0,97 et la note moyenne de pertinence de la proportion d'experts, parmi tous les experts, était de 0,99. La version Hausa adaptée du MMSE présente une sensibilité de 66,7% et une spécificité de 84,7%, lorsque le seuil original du MMSE de 24 est utilisé. Avec l'analyse ROC, les seuils optimaux 25 et 26 avec une aire sous la courbe de 0,886 (IC 95 % : 0,816-0,956 ; Erreur type : 0,036 ; P=0,000). Cependant, au seuil optimal de 26, déterminé à l'aide de l'analyse ROC, le Hausa MMSE modifié avait une sensibilité de 93,3 % et une spécificité de 71,8 %, et la fiabilité de la cohérence interne de l'outil avait une valeur alpha de 0,64. CONCLUSION: La version Hausa adaptée du MMSE est un outil de dépistage cognitif valide pour les patients adultes âgés Hausa bien que son utilisation pour le dépistage et le suivi des changements justifie la prise en compte de deux seuils distincts. Mots clés: Mini examen de l'état mental, évaluation cognitive, adultes âgés, langue Hausa.

A Review-Based Comparative Analysis of Health Care Delivery System in Nigeria and the United Kingdom.

BACKGROUND: It is a general belief that the healthcare delivery system (HCDS) in Nigeria is bedevilled by frequent workers industrial actions, inter-professional rivalry among healthcare workers and insurance scheme mismanagement and corruption. OBJECTIVE: This study was aimed at comparing the health care system in Nigeria (a lower middle-income country) and the United Kingdom (a high-income country). METHODS: Using keywords including 'primary health care', 'secondary health care', 'tertiary health care', 'health care delivery system', 'Nigeria' and ''United Kingdom, PubMed was searched for studies on health care in Nigeria and the United Kingdom. Databases of the World Bank, World Health Organization, Central Intelligence Agency World Factbook and Index Mundi were also searched for information on health indices and organisational characteristics for Nigeria and the United Kingdom. Retrieved articles and data obtained were analysed and a two-country comparison was performed on HCDS features and health indices. RESULTS: The average Life Expectancy in Nigeria is less than two third of that of the UK (54.8 years vs. 81.2 years) and the probability of dying between 15 and 60 years per thousands of population is 127.8% higher among Nigerians than among UK citizens. The Infant mortality rate per 1,000 live births and the under-five children mortality rate is 16 and 23 times higher in Nigeria than in the UK. The probability of dying on or before the first year of life and before the age of five is 177% and 183% higher respectively, in Nigeria than in the UK. While the UK ranked within the top 2% -10% on health system rating features such as achievement of goals, health care services distribution and overall goal achievement on HCDS, Nigeria is ranked within the bottom 2%-5% in these measures. DISCUSSION: Using the HCDS in the UK as a model, it can be argued that a multi-faceted approach that includes attitudinal and behavioural changes among the healthcare workers, proactive health and social policy implementation and monitoring, preventive and corrective anti-corruption measures, population control and increased healthcare spending may be needed to address challenges and improve Nigeria's healthcare rating and ranking among countries.

Learning Styles of Physiotherapy and Medical Students in a Nigerian University.

BACKGROUND: Knowledge of students learning style is important in order for an instructor to be able to determine and select the appropriate teaching techniques for effectiveness and maximized student learning during a class session. OBJECTIVES: This study was aimed at exploring the learning preferences of physiotherapy and medical students in a regional university in Nigeria. METHODS: A sample of 263 undergraduate physiotherapy and medical students in the clinical phase of their studies at the University of Maiduguri participated in this cross-sectional survey study. The participants completed a two part question-naire. Part I of the questionnaire elicits sociodemographic information such as age, gender and programme and level of study, while part II consists of a 24-item self-administered Learning Style Inventory that elicited information on the students' preferences on learning their subjects. RESULTS: These cohorts of medical and physiotherapy students were evenly divided between visual and auditory learning preferences. While for the medical students, the males tend to be visual learners more frequently than their female counterparts, gender difference in types of learning preference was not observed for the physiotherapy students. CONCLUSION: This study affirms the heterogeneity in students' learning preferences, and also suggests the need for instructors in health disciplines to always consider blending appropriate voice and audios with pictures, photos and visual effects in other to maximize students learning especially during teaching sessions.

Aerobic Exercise Improves Quality of Life and CD4 Cell Counts in HIV Seropositives in Nigeria.

BACKGROUND: Studies that examine the effectiveness of exercise on quality of life and CD4 cells of HIV population are not easily available in developing countries. PURPOSE: This study was therefore aimed at investigating the effect of 12 weeks aerobic exercise on quality of life and CD4 cells of HIV seropositives in Nigeria. METHODS: Using convenient sampling, 91 volunteer and willing HIV infected persons were enrolled in the study. Based on inclusion criteria, 82 were eligible for the study, and randomly assigned to control and experimental groups. After determining the baseline values of the variables, the experimental group participated in moderate intensity aerobic exercise for 12 weeks. Weekly lectures were organized for the control group. Attrition rate of 22% was recorded at the end the study, leaving 32 participants in each group. The variables were re-assessed at the end of the Descriptive statistic summarized the socio-demographic characteristics of the participants. Paired Student t-test and Student t-test for two independent samples analyzed the significant difference in mean values of the variables. RESULTS: Mean ages in years of the control and experimental groups were39.38 10.03 and 40.84 ± 10.05 respectively, and that of the 64 participants was 39.57±10.13. There was significant improvement (p < 0.05) in the variables between pre- and post-tests in the experimental group. There was insignificant change (p > 0.05) in the four domains of quality of life of the participants, and significant reduction (p < 0.05) in the other four domains of this variable between pre- and post-tests in the control group, in CD4 cell counts, significant improvement was recorded. The variables at the end of the study showed significant difference (p < 0.05) between both groups. CONCLUSION: Quality of life and CD4 cells of HIV seropositives in the experimental group improved significantly after 12 weeks moderate intensity aerobic exercise.

A SURVEY OF DISPOSITION OF PHYSICIANS TOWARDS PHYSICAL ACTIVITY PROMOTION AT TWO TERTIARY HOSPITALS IN NORTH-EASTERN NIGERIA.

BACKGROUND: A general presumption is that any advice from physicians would likely be taken seriously by patients, and patients are more likely to see their doctors in the event of any health complaints than any other health professionals. The perceptions and practice of Nigerian physicians on their role in physical activity promotion are not well known. This study aimed to determine the knowledge of physical activity message, confidence, role perceptions, barriers and feasibility of physical activity promotion among physicians in two tertiary health institutions in North-Eastern Nigeria. METHOD: A total of 153 (84.5% response) physicians at the University of Maiduguri Teaching Hospital and Federal Medical Center Yola completed a previously developed questionnaire that elicited information on their knowledge, barrier, feasibility, role and confidence in physical activity promotion. RESULTS: Physicians in this study reported fairly good knowledge (mean score=14.7±2.2/20), minimal or little barrier to physical activity promotion (mean score=24.4±3.5/30), perceived physical activity promotion as their role (mean score=12.9±1.6/15), were confident in their ability to discuss and recommend exercises for physical activity promotion (mean score=7.9±1.3/ 10) and believed promoting physical activity was feasible for them (mean score=15.0±2.5/20). The physicians had good disposition to physical activity promotion (Mean score=78.5±6.7/100), but male physicians showed better disposition than their female counterparts. CONCLUSION: Overall these cohorts of physicians are somewhat knowledgeable on physical activity promotion and are positively disposed to promoting physical activity among their patients. These findings can be leveraged upon to optimize outcome of campaigns or interventions to change physical activity behaviour in Nigerian populace.

Knowledge and attitude of health professional students toward patients living with AIDS.

INTRODUCTION: What health professional students know of AIDS and their attitudes towards PLWA enrich our knowledge in assuring quality of care administered to AIDS patients. OBJECTIVES: This study was designed to assess 1) What Nigerian students in various health disciplines know about AIDS and how they behave towards PLWA. and 2) Determine the sociodemographic variables that could influence knowledge of AIDS and behaviour towards PLWA among students of the various health disciplines in a university in North- Eastern Nigeria. METHODS: This cross-sectional study involving student volunteers (n=644) in the last two years of their professional training drawn from six disciplines were surveyed using a two-part questionnaire. Section I of which elicited students' sociodemographic and previous AIDS encounter information, and section II assessed knowledge and behaviour towards PLWA. RESULTS: Students in surveyed health professions had an unsatisfactory level of knowledge on AIDS pathophysiology and their behaviour towards PLWA was negative. Gender, clinical year, religious affiliation, discipline, level of satisfaction with AIDS instructions, knowing a family member or another person with a diagnosis of AIDS and willingness to provide care for an AIDS patient influenced the students' knowledge and behaviour. CONCLUSION AND RECOMMENDATION: The study revealed a real possibility for health professional students to hesitate to care for PLWA, or render uncoordinated or fragmented care at the time of their graduation. It suggests the need for intervention to include methodical and all inclusive clinical clerkship on HIV/AIDS and small group discussions with real life case scenerios involving PLWA while in training.

Physicians and AIDS Care: Does Knowledge Influence their Attitude and Comfort in Rendering Care?

Adequate knowledge; positive attitude; and feeling of comfort are important factors in providing compassionate care to patients. The purpose of this study was to assess physicians' knowledge; attitude and global comfort in caring for patients with AIDS (PWA); to determine the sociodemographic variables that could influence physicians' attitude and global comfort; and to identify any relationship between their knowledge; attitude and comfort. Consultants and residents (N=211) in two Nigerian teaching hospitals were surveyed using a two-part questionnaire. Part I elicited sociodemographic and previous AIDS encounter information; and Part II assessed knowledge; attitude and global comfort with AIDS patients care. Nigerian physicians showed satisfactory knowledge; but they harbored negative attitude and low level of comfort in caring for PWA. Previous AIDS care experience; age and being a consultant or a senior resident influenced attitude; while male gender and knowing someone with AIDS influenced global comfort. Knowledge is weakly but positively associated with attitude; while attitude is modestly associated with comfort. The study reinforced the need for an ongoing education focused on experiential learning; and professional socialization in order to influence physicians' attitude and enhance their feeling of comfort when caring for PWA

Influence of parental socioeconomic status on casual blood pressures of Nigerian school children.

The purpose of this study was to determine the effect of parental socioeconomic status on blood pressures of Nigerian school children. The weight, height, blood pressure and heart rate of 807 school children in Ile-Ife, Nigeria were measured. The subjects' ages ranged between 8 and 20 years. The subjects were classified into three (lower, middle and upper) groups based on the socioeconomic status of their parents. The findings revealed that parental socioeconomic status has no effect on the systolic and diastolic pressure, heart rate, rate pressure product and pulse pressure of Nigerian children. We found the 95th centile blood pressure to be 133/92 mm Hg. If the 95th centile is considered the diagnostic criteria for hypertension, then Nigerian children with sustained blood pressure in excess of 133/92 mm Hg should be investigated.

Anthropometric determinants of resting blood pressure and heart rate of Nigerian school children.

Blood pressure, heart rate and anthropometric parameters were measured in 807 Nigerian school-age children. There was no significant difference between the blood pressure and heart rate of boys and girls after adjusting for differences in age and anthropometric parameters. The stepwise regression analysis revealed that the strong determinants of blood pressure levels were weight, Quetelet index and triceps skinfold thickness. Based on our findings, we recommend that body weight norms rather than age should be used in evaluating abnormal blood pressure levels in Nigerian children.