Search

Objective: To examine the perceived impact of COVID-19 lockdown on access to healthcare services, food affordability, and family income during the first phase of the pandemic among married people of a resource-limited primary care setting in Kano, Nigeria. Methods: This survey involved 432 married respondents systematically selected from attendees of a primary care clinic in Kano, Nigeria, using a structured questionnaire. Results: Over half (53.5%) of respondents or their family members fell ill during the lockdown; 67.1% felt it difficult to access hospital treatment, while 32.9% sick patients resorted to self-medication. Over half (57.2%) could afford food as they used to, 75.0% reported that food items were costly, while 35.9% received government assistance. Only 29.9% had employment, of which 49.6% received a salary, while 29.5% had their salaries reduced. Educational level was significantly associated with ease of accessing healthcare services (χ2 =8.528, P=0.014). Age (χ2=12.209, P

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.

Background: Poorly managed hypertension is still a serious global public health issue, despite medication. It is unclear what is causing treated hypertensive patients to have trouble achieving their target blood pressure (BP). Aim: The goal of this study was to determine the predictors of BP control amongst hypertensive patients attending a teaching hospital in North-eastern Nigeria. Materials and Methods: A cross-sectional study was conducted on 277 hypertensive patients from a tertiary healthcare institution. Data were analysed using version 20 of the Statistical Package for the Social Sciences (SPSS). Frequency and percentages were used to summarise data while Chi-square test was used to test for associations. To identify the factors linked to BP control, logistic regression was employed. At P < 0.05, predictors of BP control were found using adjusted odds ratios (AORs) with a 95% confidence interval (CI). Results: The respondents' average age was 53.1 ± 14.6 years, of which 67.5% were female. The level of optimal BP control was 40.8%. Factors associated with reduced BP control include not currently married (AOR = 0.29 [95% CI: 0.16–0.53], P ≤ 0.0001), imperfect adherence (AOR = 0.37 [95% CI: 0.22–0.64], P ≤ 0.0001), taking more than two drugs (AOR = 0.3 [95% CI: 0.14–0.64], P = 0.001) and body mass index (BMI) ≥25 kg/m2 (AOR = 0.40 [95% CI: 0.22–0.72], P = 0.002). Conclusion: The optimal BP control is alarmingly low in this setting. Marital status, medication adherence, increased pill burden and BMI ≥25 kg/m2 negatively affect the attainment of BP control.

Background: Birth preparedness and complication readiness (BPCR), a component of focused antenatal care, has a great potential to reducing maternal and newborn deaths in low-income countries. However, the success of this strategy is not well known in most of sub-Saharan Africa, and the effectiveness of the strategy has not been widely studied. Aims: This study aimed at evaluating the effects of BPCR on pregnancy outcome. Materials and Methods: This was an observational cohort study of eligible consecutive pregnant women presenting in labour at a tertiary hospital in Abakaliki, Nigeria. Maternal and neonatal outcomes of labour were compared between women who had a birth plan (n = 115) and a control group without a birth plan (n = 115). Results: The mean age of the parturients was 27.87 ± 5.20 years. Women who had a birth plan were less likely to have postpartum anaemia (P < 0.001), receive blood transfusion (P < 0.001), and have prolonged hospital stay (P = 0.03). Their neonates were at less risk of low birth weight (P = 0.02) and admission into newborn special care unit (P = 0.003). There was no association between BPCR and incidence of Caesarean section (P = 0.65) and maternal satisfaction (P = 0.20). Conclusion: The practice of BPCR in Abakaliki, Nigeria, is associated with some favourable maternal and neonatal outcomes. The study findings indicate the need for more advocacies for adequate implementation of BPCR during pregnancy in 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.

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.

Background: Insufficient physical activity (PA) is a recognized risk factor for noncommunicable diseases. Evaluating health-care workers' PA is crucial because PA impacts their health, and they are important health promotion agents. Hence, this study assessed the PA profile of medical practitioners in Kano, Nigeria. Materials and Methods: This was a cross-sectional study involving 178 medical practitioners selected from attendees of a 1-day continuing-medical-education lecture, using a modified physical activity assessment tool. It assessed the moderate- and vigorous-intensity PAs performed, PAs' sufficiency, their plan and confidence of increasing PA, and factors associated with performing sufficient PA. Chi-square test and logistic regression analysis were employed in determining the association between variables and sufficient PA and predictors of sufficient PA, respectively. Results: Respondents' mean age was 37.5 ± 9.5 years; they were predominantly males (133, 74.7%). They spent a median (interquartile range [IQR]) of 65.0 (22.5–165.0) minutes per week on moderate-intensity activities and median metabolic equivalent-minutes/week (IQR) of 400.0 (120.0–1140.0). Most respondents (119, 66.8%) had engaged in PA in the past 5–6 months or intended to become more physically active in the next six months. Most (155, 87.1%) had some level of confidence in increasing their PA levels. The association between respondents' sociodemographic variables and sufficient PA was statistically insignificant. However, engagement in moderate-intensity housework (odds ratio [OR] = 2.39, 95% confidence interval [CI] = 1.15–4.96, P = 0.02) and aerobic exercises (OR = 11.57, 95% CI = 1.29–103.63, P = 0.03) increased the odds of attaining sufficient PA. Conclusion: Sufficient PA prevalence among respondents was low. Engagement in moderate-intensity housework and aerobic exercises were predictors of sufficient PA. Most respondents were motivated to become physically active in the future. Appropriate interventions are required to improve their PA levels.

Objective: To assess the proportion of caregivers of children and patients who received malaria prevention counseling from their healthcare provider at the time of outpatient malaria treatment. Methods: This was a descriptive cross-sectional study involving 353 randomly selected adult patients and caregivers of children attending the general and paediatric outpatient clinics of a Nigerian hospital. An interviewer-administered questionnaire was used to collect data on participants’ sociodemographics and last malaria-episode characteristics. Chi square test and logistic regression analysis were used to determine factors associated with and predictors of receiving malaria-prevention counseling, respectively. Results: The mean age of the respondents was (33.6±9.6) years; they were predominantly females (257, 72.8%). Most had at least secondary-level education (304, 86.1%); the family size was mostly 1-6 persons in 202 (57.2%) respondents. They were treated mostly by doctors 256 (72.5%), but only 132 (37.4%) received malaria prevention counseling. Educational-level (χ2 =5.42, P=0.02), family size (Fisher’s exact, P=0.01), place of treatment (Fisher’s exact, P=0.0002), pretreatment malaria test (χ2 =9.48, P=0.002), who prescribed treatment (Fisher’s exact P=0.001), consultation time (χ2 =22.09, P

Introduction: Handwashing has been proven to reduce the risk of acquiring infection; this is why every 15th October is being set aside as Global Handwashing Day, which aims at improving global awareness on the importance of handwashing. Materials and Methods: The study was cross-sectional, parents/caregivers were consecutively recruited over 8 months, and pretested questionnaire was administered by the researchers and trained assistants. Results: There were 102 (32%) males and 217 (68%) females with a male-to-female ratio of 1:2.1. A total of 279 (87.5%) respondents reported that they were aware of the moments of hand hygiene. Their relations (38.3%) were the most common source of information on hand hygiene. However, soap and water (72.4%) were the predominant items used for handwashing. Furthermore, 317 (99.1%) respondents were incorrect on the steps of handwashing technique. All respondents (100%) reported washing their hands after using the restroom. However, their educational and social status had no significant relationship with their ability to mention the steps in handwashing and the critical moments in hand hygiene, respectively, (educational status: ‡Fisher's exact = 0.440; P = 1.00, and $Fisher's exact = 3.308; P = 0.282, respectively) and (social class: ‡‡Fisher's exact = 0.756; P = 1.00 and $$Fisher's exact = 1.232; P = 1.00, respectively). However, there were statistically significant relation with adhering to the principles of handwashing (educational status: †χ2 = 7.835; df = 2; P = 0.019) and (social class: ††χ2 = 7.952; df = 2; P = 0.019), respectively. Conclusion: Majority of the respondents wash their hands especially after soiling with dirt; and water and soap were mostly used; however, the technique of handwashing was poorly understood by caregivers and this was shown to be less influenced by their educational or social status.

Objective: To assess emergency department utilization at a semi-urban (resource-limited) Nigerian hospital. Methods: A systematic random sampling technique was adopted. A proforma was used to obtain general information such as age, gender, mode of transfer, time of presentation, symptom duration, diagnoses, treatment duration, treatment outcome (transfer to the ward, referral to another hospital, discharge or death) and date and time of discharge. Chi-square test and logistic regression analysis were used to determine the association of variables with mortality and predictors, respectively. Results: Patients were predominantly male (62.2%) with a mean age of (36.0±19.0) years. Most visits occurred in September (49.1%). The median symptom duration was 24 h (interquartile range: 4.0, 72.0 ). More incidences were caused by non-surgical (61.9%) than surgical reasons. Infectious diseases (predominantly malaria, 34.5%) and injuries from road traffic accidents (mostly head injuries, 9.4%) were the commonest non-surgical and surgical cause, respectively. The mortality rate was 9.2%. Typhoid-intestinal-perforation and sepsis contributed 45.2% of overall mortality. Age (χ2=16.44, P

Background: Snakebite envenoming is a neglected tropical disease that accounts for preventable morbidity and mortality, especially in resource-limited settings. This review aimed at examining the snake and human behaviors that facilitate snake-human encounters and highlighting the primary preventive measures for snakebite and the resultant envenoming. Materials and Methods: Google Scholar, Medline (via PubMed), and African Journal Online were searched from January 1959 to April 2019 for peer-reviewed studies addressing primary prevention of snakebite. We extended our search to grey literature from conference proceedings, documents from organizations, book chapters, and thesis. Results: We found few studies in medical literature on community knowledge of the intrinsic characteristics of snakes (e.g., its unique venom apparatus for nutrition, defense and competition, and its habitat and activities); however, there is appreciable amount of studies on human activities associated with snakebite envenoming. Deservedly, more studies appear to focus on snakebite management (secondary and tertiary prevention) with inadequate emphasis on primary prevention of snakebite (which may be the only intervention in some resource-limited settings). Conclusion: Synergy of efforts toward improving community knowledge of human behaviors associated with snakebite and snake behaviors may generate appropriate environmental and behavioral responses to curtail human-snake encounters. Hence, intensive promotion of primary prevention may be a useful approach toward reducing snakebite burden in resource-limited settings.

Introduction: Elevated blood pressure (BP)/hypertension contributes significantly to global morbidity and mortality. It is a silent killer; therefore, earlier diagnosis is imperative. A simple instrument called sphygmomanometer measures BP. Getting an accurate and precise reading is essential for making the diagnosis. Our study sorts to determine if there is any significant change in BP readings when the bladder cuff is inverted during BP measurement. Materials and Methods: This was a cross-sectional study involving 540 individuals who were consecutively recruited from the outpatient clinics over a year period. BP was measured with a mercury sphygmomanometer in three postures of sitting, standing, and supine comparing the standard protocol (control) and our designed protocol of inverted cuff (test). Results: The mean systolic and diastolic BP for all the postures for both sexes were significantly corresponding for both test positions in majority of the age groups; all observed differences in means were

Background: Globally, cervical cancer affects approximately 528,000 women each year, with about 80% of them occurring in developing countries. Developed countries have successfully reduced the incidence of cervical cancer by 70% through organized cervical screening programs. Objective: The aim of the study is to assess the level of Pap smear awareness and utilization among adult females attending the general outpatient clinic of Aminu Kano Teaching Hospital, Northwestern Nigeria, in order to encourage early detection of premalignant cervical cancer. Methods: This was a descriptive cross-sectional study that assessed Pap smear awareness, utilization, and pattern of cervical intraepithelial neoplasia among 422 adult females in Kano, Northwestern Nigeria, using an interviewer-administered questionnaire. SPSS version 20 was used to analyze the data. The sociodemographic characteristics of participants, risk factors of cervical cancer, and awareness and utilization of Pap smears by participants were expressed in means and proportions. The Chi-square test was used to explore associations between categorical variables. Logistic regression was performed to identify the predictors of Pap smear awareness and its utilization among the study participants. P < 0.05 was considered statistically significant. Results: Of the 422 women who participated in the study, the majority (292, 69.2%) had never heard of Pap smear screening while 130 (30.8%) were aware of Pap smear. Similarly, 342 (81.0%) women who participated in the study had never undergone a Pap smear. Three hundred and eight (74%) had normal cytology results, 107 (25%) had inflammatory changes, 4 (0.8%) had low-grade squamous intraepithelial lesion, and 1 (0.2%) had high-grade squamous intraepithelial lesion. Having higher education and being employed were associated with Pap smear awareness while increasing age and educational level were associated with Pap smear utilization. Conclusion: This study revealed a low awareness and utilization of Pap smear screening in Northwestern Nigeria.

Venomous snakebite is a medical emergency encountered worldwide, especially in resource-limited communities. It usually leaves victims at the mercy of traditional care, whose effectiveness have come under scrutiny over time. Several of these traditional/ first aid practices have also been reported over time. Controversies over their efficacy often result in confusion among snakebite victims, their caregivers, and sometimes, among health-care providers. This narrative review describes reported prehospital interventions for venomous snakebites highlighting their usefulness, dangers, and/or limitations associated with their use and the currently widely recommended prehospital activities for venomous snakebite.