The Nigerian Aging Males' Symptoms scale. Experience in elderly males.

BACKGROUND: The Aging Males' Symptoms scale (AMS) is an internationally used scale to analyse health related quality of life (HRQoL). The aim of this paper is to provide evidence that the Nigerian AMS scale measures HRQoL with similar accuracy as in other language versions. We also intended to show the severity of complaints of aging in males in advanced old age. More generally, we aim to demonstrate that the Nigerian AMS scale is an applicable, validated, sensitive instrument to measure HRQoL in Nigeria. MATERIAL: We performed a representative survey in Nigeria to get data of the AMS scale in a group of males in old age. The survey was a household-based population sample conducted in March 2006. The Nigerian data were compared with existing data from other European countries. Only community-based data were used for this comparison. RESULTS AND DISCUSSION: The internal structure of the AMS (factorial analysis) was sufficiently similar with the comparison group of other countries in Europe to conclude that the scale really measures the same phenomenon. The sub-scores and total score correlations were high (0.8-0.9) but lower among the sub-scales (0.4-0.8). This suggests that the domains are not fully independent. The reliability (consistency) was found to be good and almost identical with European countries. Mean scores of the Nigerian AMS did systematically differ from data of other European studies. There were much higher because of older age. The same applies for the population reference values obtained in Nigeria. It is the first time that population norm values are available for very old age. CONCLUSION: The Nigerian AMS scale is a standardized HRQoL scale that showed good psychometric characteristics (reliability, validity) similar to other international versions. We suggest that the results obtained with the Nigerian AMS scale should be used preliminarily as reference for 'norm values' for highest age, i.e. in absence of other data. Confirmation in future studies is needed.

Barriers to accessing health care in Nigeria: implications for child survival.

BACKGROUND: Existing studies indicate that about one in every six children dies before age five in Nigeria. While evidence suggests that improved access to adequate health care holds great potential for improved child survival, previous studies indicate that there are substantial barriers to accessing health care in Nigeria. There has not been a systematic attempt to examine the effects of barriers to health care on under-five mortality in Nigeria. This study is designed to address this knowledge gap. DATA AND METHOD: Data came from a nationally representative sample of 18,028 women (aged 15-49) who had a total of 28,647 live births within the 5 years preceding the 2008 Nigeria Demographic and Health Survey. The risk of death in children below age five was estimated using Cox proportional hazard models and results are presented as hazards ratios (HR) with 95% confidence intervals (CI). RESULTS: Results indicate higher under-five mortality risks for children whose mothers had cultural barriers and children whose mothers had resource-related barriers to health care (HR: 1.44, CI: 1.32-1.57, p<0.001), and those whose mothers had physical barriers (HR: 1.13, CI: 1.04-1.24, p<0.001), relative to children whose mothers reported no barriers. Barriers to health care remained an important predictor of child survival even after adjusting for the effects of possible confounders. CONCLUSION: Findings of this study stressed the need for improved access to adequate health care in Nigeria through the elimination of barriers to access. This would enable the country to achieve a significant reduction in childhood mortality.