Adherence to antiretroviral therapy and its determinants among persons living with HIV/AIDS in Bayelsa state, Nigeria.

BACKGROUND: A high level of adherence is required to achieve the desired outcomes of antiretroviral therapy. There is paucity of information about adherence to combined antiretroviral therapy in Bayelsa State of southern Nigeria. OBJECTIVES: The objectives of the study were to determine the level of adherence to combined antiretroviral therapy among the patients, evaluate the improvement in their immune status and identify reasons for sub-optimal adherence to therapy. METHODS: The cross-sectional study involved administration of an adapted and pretested questionnaire to 601 consented patients attending the two tertiary health institutions in Bayesla State. NIGERIA: The Federal Medical Centre, Yenagoa and the Niger-Delta University Teaching Hospital Okolobiri. The tool was divided into various sections such as socio-demographic data, HIV knowledge and adherence to combined antiretroviral therapy. Information on the patient's CD4+ T cells count was retrieved from their medical records. Adherence was assessed by asking patients to recall their intake of prescribed doses in the last fourteen days and subjects who had 95-100% of the prescribed antiretroviral drugs were considered adherent. RESULTS: Three hundred and forty eight (57.9%) of the subjects were females and 253 (42.1%) were males. The majority of them, 557 (92.7%) have good knowledge of HIV and combined anti-retroviral therapy with a score of 70.0% and above. A larger proportion of the respondents, 441 (73.4%), had ≥95% adherence. Some of the most important reasons giving for missing doses include, "simply forgot" 147 (24.5%), and "wanted to avoid the side-effects of drugs" 33(5.5%). There were remarkable improvements in the immune status of the subjects with an increment in the proportion of the subjects with CD4+ T cells count of greater than 350 cells/mm3 from 33 (5.5%) at therapy initiation to 338 (56.3%) at study period (p<0.0001). CONCLUSION: The adherence level of 73.4% was low which calls for intervention and improvement. The combined antiretroviral therapy has significantly improved the immune status of the majority of patients which must be sustained. "Simply forgot" was the most important reason for missing doses.

Adherence to antiretroviral therapy and its determinants among persons living with HIV/AIDS in Bayelsa state, Nigeria

Background: A high level of adherence is required to achieve the desired outcomes of antiretroviral therapy. There is paucity of information about adherence to combined antiretroviral therapy in Bayelsa State of southern Nigeria. Objectives: The objectives of the study were to determine the level of adherence to combined antiretroviral therapy among the patients, evaluate the improvement in their immune status and identify reasons for sub-optimal adherence to therapy. Methods: The cross-sectional study involved administration of an adapted and pretested questionnaire to 601 consented patients attending the two tertiary health institutions in Bayesla State, Nigeria: The Federal Medical Centre, Yenagoa and the Niger-Delta University Teaching Hospital Okolobiri. The tool was divided into various sections such as socio-demographic data, HIV knowledge and adherence to combined antiretroviral therapy. Information on the patient's CD4+ T cells count was retrieved from their medical records. Adherence was assessed by asking patients to recall their intake of prescribed doses in the last fourteen days and subjects who had 95-100% of the prescribed antiretroviral drugs were considered adherent. Results: Three hundred and forty eight (57.9%) of the subjects were females and 253 (42.1%) were males. The majority of them, 557 (92.7%) have good knowledge of HIV and combined anti-retroviral therapy with a score of 70.0% and above. A larger proportion of the respondents, 441 (73.4%), had ≥95% adherence. Some of the most important reasons giving for missing doses include, «simply forgot» 147 (24.5%), and «wanted to avoid the side effects of drugs» 33(5.5%). There were remarkable improvements in the immune status of the subjects with an increment in the proportion of the subjects with CD4+ T cells count of greater than 350 cells/mm3 from 33 (5.5%) at therapy initiation to 338 (56.3%) at study period (p<0.0001). Conclusion: The adherence level of 73.4% was low which calls for intervention and improvement. The combined antiretroviral therapy has significantly improved the immune status of the majority of patients which must be sustained. «Simply forgot» was the most important reason for missing doses (AU)

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Prevalence and control of hypertension in a Niger Delta semi urban community, Nigeria.

BACKGROUND: Hypertension is a public health problem worldwide, but the prevalence in Amassoma, Southern Ijaw Local Government Area is not known. OBJECTIVE: To investigate the prevalence of hypertension in the locality and the extent of control in diagnosed cases. METHODS: It is a prospective study involving interviewing. Four hundred adults aged 20 years and above selected through stratified random sampling across the various compounds called "AMA"; a unit of settlement comprising extended families of common ancestors. A self-developed, validated and pretested interviewer-administered questionnaire on demographics, predisposing factors, and medication history was used. In addition, measurement of respondents' blood pressure, weight and height was carried out. The Body Mass Index calculated and the data were appropriately analysed. RESULTS: The response rate of questionnaire distribution was 100.0% being interviewer administered alongside weight, height and blood pressure measurement. Majority of respondents were female. Almost half of respondents (46.5%) had their BMI above normal, 15.3% (61) of which falls within the obese region (>30.0kg/m2). The mean (SD) systolic blood pressure among males was 133.3 (3.2) mmHg and that of females was 127.4 (3.0) while the mean (SD) diastolic blood pressures were 86.2 (1.7) and 83.9 (2.4) for males and females respectively. Crude prevalence rate of hypertension in the community was 15.0% (60) out of which 13.8 % (55) were previously diagnosed. The hypertension was that of Stage I in 11.5% (46) and Stage II in 3.5% (14). Hypertension prevalence was slightly higher in males (18.8%) than that of the females (12.5%) (p= 0.0889), Relative Risk (RR)=1.500 [95%CI 0.9422:2.388]. The prevalence rate among 40 years and above was 41.6% (42/101) who also constituted 70.0% (42/60) of participants with hypertension in the survey and 10.5% (42/400) of the total. Of the previously diagnosed cases of hypertension, only 31% (17/55) were taking their drugs during the survey and only 12.7% (07/55) had regular adherence to medication and adequate BP control was achieved in 7.3% (04/55). Majority of the patients on drugs (21.8%) (12/55) were either taking methydopa as monotherapy or in combination with amiloride and hydrochlorothiazide. Other drugs being taken by patients include lisinopril, propranolol, amlodipine, atenolol, nifedipine and low dose aspirin. CONCLUSIONS: The prevalence of hypertension in the semi urban community is 15.0% with a pre-hypertension in another 23.5%. There was poor control of blood pressure among previously hypertensive patients.

Prevalence and control of hypertension in a Niger Delta semi urban community, Nigeria / Prevalencia y control de la hipertensión en una comunidad semi-urbana del delta del Níger, Nigeria

Background: Hypertension is a public health problem worldwide, but the prevalence in Amassoma, Southern Ijaw Local Government Area is not known. Objective: To investigate the prevalence of hypertension in the locality and the extent of control in diagnosed cases. Methods: It is a prospective study involving interviewing. Four hundred adults aged 20 years and above selected through stratified random sampling across the various compounds called “AMA”; a unit of settlement comprising extended families of common ancestors. A self-developed, validated and pretested interviewer-administered questionnaire on demographics, predisposing factors, and medication history was used. In addition, measurement of respondents’ blood pressure, weight and height was carried out. The Body Mass Index calculated and the data were appropriately analysed. Results: The response rate of questionnaire distribution was 100.0% being interviewer administered alongside weight, height and blood pressure measurement. Majority of respondents were female. Almost half of respondents (46.5%) had their BMI above normal, 15.3% (61) of which falls within the obese region (>30.0kg/m2). The mean (SD) systolic blood pressure among males was 133.3 (3.2) mmHg and that of females was 127.4 (3.0) while the mean (SD) diastolic blood pressures were 86.2 (1.7) and 83.9 (2.4) for males and females respectively. Crude prevalence rate of hypertension in the community was 15.0% (60) out of which 13.8 % (55) were previously diagnosed. The hypertension was that of Stage I in 11.5% (46) and Stage II in 3.5% (14). Hypertension prevalence was slightly higher in males (18.8%) than that of the females (12.5%) (p= 0.0889), Relative Risk (RR)=1.500 [95%CI 0.9422:2.388]. The prevalence rate among 40 years and above was 41.6% (42/101) who also constituted 70.0% (42/60) of participants with hypertension in the survey and 10.5% (42/400) of the total. Of the previously diagnosed cases of hypertension, only 31% (17/55) were taking their drugs during the survey and only 12.7% (07/55) had regular adherence to medication and adequate BP control was achieved in 7.3% (04/55). Majority of the patients on drugs (21.8%) (12/55) were either taking methydopa as monotherapy or in combination with amiloride and hydrochlorothiazide. Other drugs being taken by patients include lisinopril, propranolol, amlodipine, atenolol, nifedipine and low dose aspirin. Conclusion: The prevalence of hypertension in the semi urban community is 15.0% with a prehypertension in another 23.5%. There was poor control of blood pressure among previously hypertensive patients (AU)

Antecedentes: La hipertensión es un problema de salud pública mundial, pero la prevalencia en Amassoma, Región del gobierno local de Southern Ijaw, es desconocida. Objetivo: Investigar la prevalencia de hipertensión en la localidad y el grado de control de los casos diagnosticados. Métodos: Estudio prospectivo que incluyó una entrevista. Se seleccionó a 400 adultos de 20 años o más mediante un muestreo aleatorio estratificado en los varios sectores llamados “AMA”; la unidad familiar comprendía las familias con los antepasados comunes. Se utilizó un cuestionario auto-desarrollado, validado y pre-testeado administrado por encuestador sobre demografía, factores predisponentes y medicación. Además, se realizó una medición de presión arterial, peso y altura de los respondedores. Se calculó el índice de masa corporal y se analizaron los datos pertinentemente. Resultados: La tasa de respuesta de la distribución del cuestionario fue del 100%, siendo el entrevistador quien midió peso, altura y presión arterial. La mayoría de los respondentes eran mujeres. Casi la mitad de los respondentes (46,5%) tenían un IMC por encima de lo normal, 15,3% (61) de ellos estaban en la zona de obesidad (>30,0 kg/m2). La media (DE) de la presión arterial sistólica entre hombres era de 133,3 (3,2) mmHg y en mujeres de 127,4 (3,0), mientras que la media (DE) de la presión arterial diastólica fue de 86,2 (1,7) y de 83,9 (2,4) para hombres y mujeres, respectivamente. La tasa de prevalencia cruda de hipertensión en la comunidad fue del 15,0% (60) de los que el 13,8% (55) habían sido previamente diagnosticados. La hipertensión era de estadio I en el 11,5% (46) y de estadio II en el 3,5% (14). La prevalencia de hipertensión fue ligeramente mayor en hombres (18,8%) que en mujeres (12,5%) (p=0,0889; riesgo relativo (RR)=1,500 [IC95%= 0,9422:2,388]. La tasa de prevalencia entre los de 40 años o más fue del 41,6% (42/101) que también constituían el 70,0% (42/60) de los participantes con hipertensión en el estudio y el 10,5% (42/100) del total. De los casos previamente diagnosticados de hipertensión, sólo el 31% (17/55) estaban tomando medicamentos regularmente durante la encuesta y sólo el 12,7% cumplían regularmente la medicación y se alcanzó el control adecuado de la presión arterial en el 7,3% (4/55). La mayoría de los pacientes medicados (21,8%) (12/55) estaban o con metildopa en monoterapia o en combinación de amiloride and hydrochlorothiazide. Otros medicamentos utilizados incluían lisinopriolo, propranolol, amlodipina, atenolol, nifedipina y bajas dosis de aspirina. Conclusión: La prevalencia de hipertensión en el área semi-urbana es del 15,0% con una prehipertensión en otro 23,5%. Había in pobre control de la presión arterial entre los pacientes previamente diagnosticados (AU)