Health-Related Quality of Life and Its Determinants Among Hypertensive Patients in Rural Southwest Nigeria.

BACKGROUND: The health-related quality of life (HRQOL) of patients with hypertension is of particular concern to stakeholders because hypertension is a chronic disease. OBJECTIVES: To determine the pattern of HRQOL and its determinants among hypertensive patients in rural Southwestern Nigeria. SUBJECTS, MATERIALS AND METHODS: Ahospital-based crosssectional survey was conducted between June and October 2019 on 390 consented adult patients with hypertension on follow-up using systematic sampling technique. Respondents'blood pressure (BP), body mass index (BMI), waist circumference (WC), waist-hip ratio (W-HR) and other measurements were taken. Relevant data on socio-demographics and lifestyle behaviours were collected using an interviewer-administered questionnaire which incorporated validated instrument for assessment of HRQOL score using SF-12 survey. The data were analyzed using SPSS (version 21). Binary logistic regression was used to identify the determinants of HRQOL. RESULTS: The mean physical component summary (42.0 ± 8.44), mental component summary (40.6 ± 8.11), and mean overall quality of life score (41.3 ± 8.17) were all below the normal score of 50 ±10. However, of all the eight domains, the role emotional was the highest (47.61 ± 14.97). The odds of having overall good HRQOL were better with respondents with female gender (AOR=1.99, 95% CI: 1.05-3.88), tertiary education (AOR=3.22, 95% CI: 1.63-7.20), and controlled BP (AOR=3.01,95% CI: 1.04-15.79). CONCLUSION: The mean HRQOLscore of the respondents was below the mean score. The findings of this study would assist stakeholders in decision-making towards improved management of patients with hypertension.

CONTEXTE: La qualité de vie liée à la santé (HRQOL) des patients hypertendus est une préoccupation particulière pour les parties prenantes car l'hypertension est une maladie chronique. OBJECTIFS: Déterminer le modèle de la HRQOL et ses déterminants chez les patients hypertendus en milieu rural du sud-ouest du Nigéria. SUJETS, MATÉRIAUX ET MÉTHODES: Une enquête transversale hospitalière a été menée entre juin et octobre 2019 sur 390 patients adultes atteints d'hypertension en suivi, consentis, en utilisant une technique d'échantillonnage systématique. La pression artérielle (PA), l'indice de masse corporelle (IMC), la circonférence de la taille (CT), le rapport taillehanche (W-HR) et d'autres mesures ont été prises chez les répondants. Les données pertinentes sur les caractéristiques sociodémographiques et les comportements liés au mode de vie ont été collectées à l'aide d'un questionnaire administré par un enquêteur, intégrant un instrument validé pour l'évaluation du score HRQOL à l'aide de l'enquête SF-12. Les données ont été analysées à l'aide de SPSS (version 21). La régression logistique binaire a été utilisée pour identifier les déterminants de la HRQOL. RÉSULTATS: Le résumé de la composante physique (42,0 ± 8,44), la composante mentale (40,6 ± 8,11) et le score moyen de qualité de vie global (41,3 ± 8,17) étaient tous en dessous du score normal de 50 ± 10. Cependant, de tous les huit domaines, le rôle émotionnel était le plus élevé (47,61 ± 14,97). Les chances d'avoir une HRQOL globale satisfaisante étaient meilleures chez les répondants de sexe féminin (AOR=1,99, IC à 95 % : 1,05-3,88), ayant une éducation tertiaire (AOR=3,22, IC à 95 % : 1,63-7,20) et une PAcontrôlée (AOR=3,01, IC à 95 % : 1,04-15,79). CONCLUSION: Le score moyen de HRQOL des répondants était en dessous du score moyen. Les résultats de cette étude aideront les parties prenantes dans la prise de décision en vue d'une meilleure gestion des patients hypertendus. Mots-clés: Qualité de vie globale, Déterminants, Hypertension, Nigéria rural.

Effect of an Antidepressant on Medication Adherence among Type 2 Diabetic Patients with Depression Accessing Care in GOPC of FETHI.

Comorbid depression among diabetes mellitus (DM) patients is on the increase. This has been linked with poor glycaemic control, greater risk of complications, high burden of medical cost and health care utilisation, and worsening prevalence of other comorbidities resulting in decreased life expectancy. This study determined the antidepressant effect of amitriptyline on depression and glycaemic control among the depressed type 2 DM patients attending Federal Teaching Hospital, Ido-Ekiti (FETHI), Nigeria. It was an interventional study involving 51 depressed type 2 DM patients randomly screened using Patient Health Questionnaire-9 (PHQ-9). They had health education and oral amitriptyline 50mg at night for two months. Postintervention assessment was done using the same tool. Respondents' age ranged between 44 and 78 years with a mean age of 58±8.4 years. Post-intervention assessment showed improved depressive symptoms; 50% of the respondents had significantly improved glycaemic control with a statistically significant effect on depression (the median score of PHQ-9 reduced from 6.0 to 3.0).

La dépression comorbide chez les diabétiques est en augmentation. Elle a été associée à un mauvais contrôle de la glycémie, à un risque accru de complications, à une charge élevée en termes de coûts médicaux et d'utilisation des soins de santé, ainsi qu'à un taux de mortalité plus élevé chez les personnes souffrant de comorbidité. Cette étude a déterminé l'effet de l'antidépresseur (Amitriptyline) sur la dépression et le contrôle de la glycémie chez les patients dépressifs atteints de diabète de type 2 qui fréquentent l'hôpital universitaire fédéral d'Ido-Ekiti (FETHI). Il s'agit d'une étude interventionnelle portant sur 51 patients atteints de diabète de type 2 et déprimés, sélectionnés au hasard à l'aide du questionnaire sur la santé des patients 9 (PHQ-9). Ils ont bénéficié d'une éducation à la santé et ont pris 50 mg d'amitriptyline par voie orale pendant deux mois. L'évaluation post-intervention a été réalisée à l'aide du même outil. L'âge des personnes interrogées était compris entre 44 et 78 ans, avec un âge moyen de 58± 8,4 ans. L'évaluation postintervention a montré une amélioration des symptômes dépressifs, 50% des personnes interrogées ont eu un contrôle glycémique significativement amélioré avec un effet statistiquement significatif sur la dépression (le score médian du PHQ est passé de 6,0 à 3,0). Mots clés: Diabète sucré, dépression, contrôle glycémique, observance thérapeutique.

SAFETY NETTING CONCEPT IN PRIMARY CARE CONSULTATION.

Introduction: Patient safety in primary care setting is important and effort geared towards this cannot be over-emphasised. Patient safety can be achieved through various means, but one mechanism to improve patient safety in resourceconstrained settings is through a practice known as safety netting. Safety netting is widely recommended in national guidelines with varying definitions and scope; hence there is no consensus on when safety netting should be used and what should be the content. Methodology: A narrative overview of the evidence on safety netting concept in primary care consultation was conducted. Scholastic articles and Papers by International organizations were searched using terms like 'safety netting', 'primary care consultation', 'family physician', 'consultation technique', and 'patient safety' in primary care. Most resources found were in the developed countries (the West) and none was found in Africa or the Middle East.Safety netting is a technique in consultation to communicate uncertainty, provide patient information on red-flag symptoms, and plan for future appointments to ensure timely re-assessment of a patient's condition. The content of safetynetting advice may encompass the chronology of the illness, advice on worrying symptoms to look out for, and specific information on how, when and where to seek help. Safety netting was considered to be particularly important when consulting with the acutely unwell, patients with multi-morbidity, children and those with mental health problems. Conclusion: Safety netting is more than solely the communication of uncertainty within a consultation. It should include plans for follow-up as well as important administrative aspects, such as the communication of test results. Effective safety netting should be geared towards the patient and provide enough practical clue for self-care and re-consultation.

Patient Education and Medication Adherence among Hypertensives in a Tertiary Hospital, South Western Nigeria.

BACKGROUND: Hypertension is a global health issue among the adult population with high morbidity and mortality rates. Poor adherence to medication is associated with bad outcome of the disease and wastage of health resources. Therefore, this study aims to determine the role of patient education in medication adherence among hypertensives attending tertiary hospitals in Ekiti State, South Western, Nigeria. METHODS: This is a descriptive cross-sectional study involving 420 participants attending Family Medicine Department Clinic of Federal Medical Centre (FMC), Ido-Ekiti. Relevant data were collected using semi-structured questionnaire. RESULTS: The mean age of respondents was 60.97 ± 11.28 years, and a slight female preponderance (male: female = 1:1.7 over male). Three hundred and forty nine (83.1%) were married, 273(65.0%) were from a monogamous family and 375(89.2%) had family sizes of more than 4. Ninety four (22.4%) had good knowledge about hypertension, and 257(61.2%) were adherent to their medication. Increased medication adherence proportion was observed as knowledge about hypertension improves. The odds of adherence to treatment among subjects with good knowledge is 2 times (OR = 2.320, 95%CI = 1.164, 4.626) higher than among subjects with poor knowledge. CONCLUSION: The proportion of respondents with good knowledge about hypertension is low. However, the adherence among them to medication is higher and statistically significant. Patient education about the disease and its treatment by primary care physicians can help to improve adherence to medication.