Systematic Literature Review of the Prevalence, Pattern, and Determinant of Multimorbidity Among Older Adults in Nigeria.

Introduction: Multimorbidity is a rising health issue globally and it is likely to become challenging in developing countries like Nigeria as they experience economic, demographic, and epidemiological transition. Yet, evidence of prevalence and patterns of multimorbidity, and their determinants, are scarce. This study aims to systematically review studies of the prevalence, patterns, and determinants of multimorbidity in Nigeria. Methods: Studies were identified by searching 5 electronic databases (PubMed, Web of Science, CINAHL, PsycINFO, Africa Index Medicus/Global Index Medicus). Multimorbidity as well as other versions of it was used to search. The prevalence and determinants were also searched. According to preestablished inclusion criteria, and using different search strategies, 6 articles were included. The quality and risk of bias were assessed using Joanna Briggs Institute appraisal tool for prevalence studies. Two researchers assessed the eligibility of studies for inclusion. The protocol was registered on PROSPERO Ref no. CRD42021273222. The overall prevalence, pattern, and determinants were analyzed. Results: We identified 6 eligible publications describing studies that included a total of 3332 (men 47.5%, women 52.5%) patients from 4 states plus the federal capital territory Abuja. The multimorbidity prevalence ranges from 27% to 74% among elderly Nigerians. Cardiovascular together with metabolic and/or musculoskeletal conditions were the frequent patterns of multimorbidity. A positive association was observed between age and multimorbidity in most studies. Other factors associated with multimorbidity were female gender, low education status, poor monthly income/unemployment, hospitalization, medical visits, and emergency services. Conclusion: There has been a growing need for more applied health services research to understand better and manage multimorbidity in developed countries. The scarcity of studies in our review reveals that multimorbidity is not a priority area of research in Nigeria, and this will continue to hinder policy development in that area.

Effective Hospital Care Delivery Model for Older People in Nigeria with Multimorbidity: Recommendations for Practice.

The importance of developing an effective action-based model of care for multimorbid patients has become common knowledge, but it remains unclear why researchers in Nigeria have not paid attention to the issue. Hence, this study assessed the quality of health services using the Donabedian model and aimed to recommend an effective hospital care delivery model for older people in Nigeria with multimorbidity. A cross-sectional study using face-to-face data was conducted between October 2021 and February 2022. The reported data were collated, checked, coded, and entered into JISC online survey software and then exported to IBM Statistical Package for Social Science (SPSS) version 27 for analysis, sourced from the University of West London, London, United Kingdom. The data were collected from the outpatient department of four high-volume public secondary hospitals in Niger State (the largest hospital in the three senatorial zones and that of the state capital). Systematic random sampling was used to select 734 patients with two or more chronic diseases (multimorbidity) aged 60 years and above who presented for routine ambulatory outpatient and consented to participate in the study. A Service Availability and Readiness Assessment (SARA) tool was used to assess the structure, and the process quality was assessed by the patients' experiences as they navigated the care pathway, whereas the outcome was measured using the patients' overall satisfaction. Using Spearman's correlation, no statistically significant association was observed between satisfaction level with the healthcare that was received and the five domains of health facility readiness (Total score Basic Amenities, Total score Basic Equipment, Total score infection control, Total score diagnostic capacity, Total score essential drugs), and the general facility readiness. Finally, the process component superseded the structure as the determinant of the quality of healthcare among multimorbid patients in Niger State. The emphasis of the process should be on improving access to quality of care, improving patient-physician relationships and timing, reducing the financial burden of medical care, and building confidence and trust in medical care. Therefore, these factors should be incorporated into designing the healthcare model for multimorbid patients in Nigeria.

Exploring experiences of family caregivers for older adults with chronic illness: A scoping review.

A Scoping Review was conducted to explore key issues that underpin the experiences of family caregivers of older adults with chronic illness. The review aims to identify the gap in literature and synthesise evidence on this topic. Globally, family caregivers of older adults with chronic illness experience burden. Evidence suggests that family caregivers' needs are poorly understood and remain largely under recognised by healthcare services. Moreover, little is known about the experience of family caregivers caring for older adults with multiple chronic conditions. Data bases used included: (EBSCOhost, CINAHL, Science Direct, SCOPUS, MEDLINE, PubMed, ISI web of science and grey literature. 3352 records were identified, 58 full-text articles were assessed for eligibility, and 11 papers included in the literature review. Data are narratively synthesized. This review provides findings that suggest further research.

Reconciling methodological approaches of survey and focus group.

The aim of research, be it qualitative or quantitative is either to predict describe or explain a phenomena and add to the body of knowledge within the context of a philosophical belief. Each study generates knowledge in line with a chosen paradigm, and uses appropriate data collection methods. Tw such methods are surveys and focus groups, each of which will be chosen according to the aim of the research.

Management of diabetes mellitus in clinical practice.

Diabetes is a global health problem, with a challenging epidemiology. It is one of the major health problems affecting countries around the world, particularly the UK (World Health Organization [WHO], 2006; Department of Health [DH], 2006b). It is also a growing public health threat in the US (Mokdad et al, 2001). As a result, diabetes has become an important public health issue, prompting the WHO and International Diabetes Federation (IDF) to adopt the theme 'Diabetes for Everyone' for World Diabetes Day 2006. In 2007, on World Diabetes Day, the United Nations also launched its 'Living with Diabetes at School' campaign, in response to the growing diabetes 'epidemics' (Diabetes UK, 2007). This article provides an overview of diabetes mellitus and its acute- and long-term management, including definition, aetiology, pathophysiology, classification, signs, symptoms and complications. The role of the nurse in providing patient-centred care for people with diabetes is emphasized.

Management and treatment options for epilepsy.

Epilepsy is a major chronic condition of the nervous system affecting almost 380,000 people in England and occasionally results in death of the patient. Although epilepsy and its treatment are complex, there is evidence to support a significant gap in epilepsy care, ranging from a lack of adequate record keeping of seizure occurrence to poor referral systems. This article provides a broad introduction to the condition, discusses the incidence, disease process, diagnosis, classification and the various ways, both conventional and otherwise, in which it can be managed. By understanding the above, it will assist healthcare practitioners to improve their knowledge about management of a client with epilepsy entrusted to their care.