MORBIDITY, COMORBIDITY AND MULTIMORBIDITY AS PORTALS FOR SUBJECTIVE WELL-BEING AMONG OLDER PERSONS IN A RURAL NIGERIAN ENVIRONMENT: A CROSS-SECTIONAL HOSPITAL-BASED STUDY.

Background: Subjective well-being (SWB) has been described as a new vital sign that predicts the overall health and future health status of individuals. Despite the process of natural ageing, older persons in addition suffer morbid, comorbid and multimorbid medical conditions that affect their SWB. Aim: The aim of the study was to determine the morbidity, comorbidity and multimorbidity as predictors of SWB among older persons in a rural environment of Nigeria. Methods: This was a cross-sectional study that was carried out on 214 older persons from January to December 2022 in Nigeria. Data collection was done using structured, pretested and interviewer guided questionnaire. Subjective well-being was assessed with self-rated health status questionnaire. Morbidity was determined by self-reported health problems, clinical, laboratory and radio-diagnostic methods. Co-morbidity was assessed using Self-Reported Comorbidity Questionnaire (SCQ) while multimorbidity was evaluated using multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC). Results: The study participants were aged 60-99 years with mean age of 68±4.5 years. There were 123(57.5%) females. Ninety-three(43.5%) of the study participants had good SWB. The three most common morbidities were malaria(97.2%), hypertension(69.2%) and musculo-skeletal disorders(67.8%). The commonest cardiovascular comorbidity was musculoskeletal disorders(56.1%) and one hundred and five(49.1%) of the study participants had three co-morbid chronic conditions. The prevalence of multimorbidity was 45.3%. The independent predictors of poor SWB were age≥75 years(ORs=2.103; 95%CI(1.215-4.214), P=.026); poor healthseeking behaviour(ORs=2.005; 95%CI(1.351-5.090), P=.041); presence of ≥ 3 comorbidities(ORs=3.111; 95%CI(1.465-6.910); P=.019) and presence of ≥ 3 multimorbidities(ORs=3.309; 95%CI(1.899- 7.921); P= .001). Conclusion: The study has shown the overall SWB of the study participants. The independent predictors of poor SWB were age ≥ 75 years, poor health seeking behaviour, presence of ≥ 3 comorbidities and multimorbidities. Health-seeking behaviours, comorbidities and multimorbidities should be explored during clinical consultations with older persons with poor SWB.

Family biosocial variables driving adherence to the use of insecticide treated nets among under-five children managed for malaria in a rural hospital in eastern Nigeria.

BACKGROUND: As the distribution and awareness of free insecticide treated nets (ITNs) for malaria control continues to grow in Nigeria in order to meet the coverage target for the year 2010, a large gap exists between acquiring them, using them, and adhering to its use by families of under-five children. Therefore, the family biosocial variables driving its adherence need to be explored if the potential benefits of the nets are to be fully harnessed by families of under-five children in Nigeria. This study was aimed at describing family biosocial variables driving adherence to the use of insecticide treated nets among under-five children managed for malaria in a rural hospital in Eastern Nigeria. MATERIALS AND METHODS: This was descriptive hospital-based study carried out from June 2008 to June 2010 on a cross section of 220 mothers of under-five children who were managed for confirmed malaria within the study period and met the selection criteria were interviewed using a pretested, structured researcher administered questionnaire. The questionnaire instrument elicited information on family biosocial variables. Adherence was assessed in the previous 6 months and graded using an ordinal scoring system of 1-4 points: score of 4 points indicated adherence while scores of 1-3 points meant nonadherence. Operationally, an adherent respondent was defined as one who scored 4 points. An under-five child was defined to have malaria if the mother gave complaint of fever, vomiting and other symptoms suggestive of malaria, had body temperature exceeding 37.5 degrees C with the asexual forms Plasmodium falciparum detected on the peripheral blood film. Reasons for nonadherence were also sought. RESULTS: The adherence rate was 33.2%. The family biosocial variables significantly associated with adherence were maternal age =30 years (p-value = 0.03), maternal occupation (house wives) (p-value = 0.03), family size less than 4 (p-value = 0.026) and spouse living together (p-value = 0.01.). Others included family belief, in the benefits of ITNs (p-value = 0.002 and source of ITNs (p-value = 0.03). The most significant predictor of adherence was living together of spouse (p-value = 0.000, OR = 3.851, CI = 1.76-6.01). The commonest reason for non-adherence was forgetfulness (p-value = 0.003). CONCLUSION: Despite high family belief in the benefits of ITNs, adherence to its use was low. Some family biosocial variables played significant roles in driving its adherence. Measures targeted at these variables and widespread family-oriented health promotion programmes are recommended in order to improve on adherence leading to family friendly ITNs communities.

Evaluation of patients' satisfaction with quality of care provided at the National Health Insurance Scheme clinic of a tertiary hospital in South- Eastern Nigeria.

BACKGROUND: The umpteenth threats to change of healthcare provider by dissatisfied patients on formal sector health insurance are well known and can be a proxy indicator for the need for quality improvement in service delivery. OBJECTIVE: This study was aimed at evaluating patients' satisfaction with quality of care provided at the National Health Insurance Scheme (NHIS) clinic of a tertiary hospital in South-Eastern Nigeria. MATERIALS AND METHODS: This was a descriptive study carried out on 400 NHIS patients from April 2011 to October 2011 at the general outpatient department of Federal Medical Centre, Umuahia. Patients were selected by simple random sampling using every second NHIS patient that registered to see the clinicians and who met the selection criteria. Data were collected using pretested, structured interviewer-administered questionnaire. Each satisfaction item was scored in a five-point Likert scale ordinal response, which was converted to percentage scale response. Satisfaction was measured from the following domains: accessibility, patient waiting time, patient-provider communication, patient-provider relationship, hospital bureaucracy, and hospital environment. Operationally, patients who scored 50% and above in the assessed domain were considered satisfied while those who scored less than 50% were dissatisfied. RESULTS: The overall satisfaction score of the respondents was 66.8%. Specifically, the respondents expressed satisfaction with patient-provider relationship (81.5%), patient-provider communication (79.9%), accessibility (74.2%), and hospital environment (68.2%) and dissatisfaction with hospital bureaucracy (48.8%) and patient waiting time (48.3%). CONCLUSION: This study has shown that the overall patients satisfaction with the services provided was very good with patient-provider relationship rated highest and patient waiting time the lowest. There is need to improve on the current level of patients satisfaction while effort should be made to address the identified domains of dissatisfaction.

The magnitude of atherogenic dyslipidaemia among geriatric Nigerians with systemic hypertension in a rural hospital in Eastern Nigeria.

BACKGROUND: The relevance of dyslipidaemia in the management of cardiovascular diseases, especially hypertension is an important health care challenge that is increasing worldwide. Of great concern in Nigeria is that most geriatric hypertensives with dyslipidaemia are not routinely diagnosed and therefore do not receive appropriate treatment. OBJECTIVE: This study is aimed at describing the magnitude (prevalence and pattern) of atherogenic dyslipidaemia among geriatric Nigerians with systemic hypertension in a rural hospital in Eastern Nigeria. METHODS: A descriptive hospital-based study was carried out from June 2008 to June 2011 on 122 consecutive geriatric patients with systemic hypertension who met the selection criteria at St Vincent De Paul hospital, Amurie-Omanze, a rural Mission General Hospital in Imo state. The fasting lipid profile was determined by enzymatic method. Dyslipidaemia was defined using the third report of National Cholesterol Education Panel in adult (ATP III). The data collected included age and sex. RESULTS: Fifty-four (44.3%) out of 122 patients had at least one dyslipidaemia. The age of the patients ranged from 65 years to 91 years with mean age of 69 +/- 2.10 years. There were 51 (41.8%) males and 71 (58.2) females with male to female ratio of 1: 1.4. The commonest lipid abnormality was low high density lipoprotein-cholesterol (38.5%). Others included high low density cholesterol (23.8%), high total cholesterol (17.2%) and high triglyceride (14.8%). CONCLUSION: This study has shown that dyslipidaemia exist among geriatric hypertensives in the study area with low HDL-C being the most frequent lipid abnormality suggesting that low HDL may be the major form of dyslipidaemia and a marker of dyslipidaemic cardiometabolic risk among them. Screening for dyslipidaemia should therefore form an important part of clinical care of geriatric hypertensives and those with dyslipidaemia should become target for lipid lowering treatment in addition to lifestyle modification.

Common geriatric morbidity from communicable diseases in a rural hospital in Eastern Nigeria.

BACKGROUND: The geriatric health, wellness and illness states in Nigeria are largely influenced by communicable diseases. OBJECTIVE: This study was aimed at describing the pattern of common geriatric morbidity from communicable diseases in a rural hospital in Eastern Nigeria. METHODS: This study was a descriptive hospital-based study carried out from June 2008 to June 2010 on geriatric patients at St Vincent De Paul Hospital, Amurie-Omanze, a rural Mission General Hospital in Imo state. The data collected included age, sex and diagnoses made. RESULTS: Eight hundred and seventy two patients out of a total patient population of 9885 were 65 years and above. The geriatric patients' constituted 8.8% of total patients' population. Out of these, 530 (60.8%) had communicable diseases consisting of 235 males and 295 females with a male to female ratio of 1: 1.3. The top five communicable diseases were malaria (67.1%), skin infections (43.6%), urinary tract infections (36.0%), intestinal helminthiasis (20.6%) and gastroenteritis (17.9%). CONCLUSION: This study shows that geriatric patients suffer acute and chronic communicable diseases with the commonest being malaria, skin infections, urinary tract infections and neglected tropical disease such as ascariasis and hookworm infestation. Effective measures are needed to control the scourge of communicable diseases which are largely preventable among the elderly patients particularly in rural Nigeria.

Common under-five morbidity in South-Eastern Nigeria: a study of its pattern in a rural mission general hospital in Imo State.

BACKGROUND: The under-five children are the most vulnerable group that bears the burden of diseases to a large extent in Nigeria. This study was aimed at describing the common and pattern of under-five morbidity in a rural Mission General Hospital in Imo state, South-Eastern Nigeria. METHODS: A cross sectional descriptive hospital-based study was carried out from June 2008 to June 2009 on 244 under-five children aged 4 days to 58 months. The under-five children seen within the study period who met the selection criteria were studied. The data collected included age, sex and diagnosis made. RESULTS: One hundred and seven (43.8%) out of a total of 244 under-five children studied were aged 37-60 months, eighty one (33.2%) were aged 13-36 months and fifty six (23.0%) were aged 0-12 months. There were 141 (57.8%)males and 103 (42.2%) females. The three commonest causes of morbidity were malaria infections (80.3%), acute respiratory infections (32.0%) and skin infections (29.1%). The age group 37-60 months bears the greatest burden of malaria infections (49.0%), acute respiratory infections (55.1%) and skin infections (53.5%). CONCLUSION: This study shows that the three commonest causes of under-five morbidity (malaria, acute respiratory infections and skin infections) are largely preventable and infectious diseases still remaining major causes of morbidity; and similar to the under-five morbidity pattern documented at the beginning of the implementation of Primary Health Care and Child Survival Strategies in Nigeria. Identification, implementation, monitoring and evaluation of multidisciplinary and multisectoral intervention strategies targeted at the common under-five morbidity that are culturally acceptable, scientifically proven, patient-, family- and community-friendly and centred are recommended.

Obesity in adult Nigerians: a study of its prevalence and common primary co-morbidities in a semi-urban Mission General Hospital in South-Eastern Nigeria.

BACKGROUND: Obesity is socially and culturally acceptable in Nigeria and therefore not usually recognized as a medical problem. This study is aimed at determining the prevalence of obesity using body mass index (BMI) criterion and its common primary comorbidities among adult Nigerians attending a semi-urban Mission General Hospital in Imo state, SouthEastern, Nigeria. METHODS: A descriptive study using primary data collection technique was carried out from October 2007 to December 2008. A total of 9296 consecutive new adult patients aged 18-88 years were screened for obesity using BMI criterion and 684 patients who had BMI = 30 kg/m2 met the inclusion criteria. The data collected included age, sex, marital status, education, occupation, weight (kilogram), height (meters), and blood pressure; fasting blood sugar and fasting lipid profile. Obese patients' perception of their obese condition and knowledge of lifestyle modification were also assessed. RESULTS: Six hundred and eighty-four (7.4%) out of a total of 9296 patients screened for obesity were obese. Hypertension (18.4%) was the commonest primary comorbidity, others include high triglyceridaemia (9.2%), high total cholesterol (8.2%), high LDL-cholesterol (6.0%) and diabetes mellitus (3.4%). One hundred and one (14.8%) obese patients were aware of their obese condition and majority, 72 (71.3%) of them were informed of their obese condition by healthcare professionals. Forty seven (46.5%) of those who were aware of their obese condition had knowledge of lifestyle modification. However, majority (72.3%) of those who had knowledge of lifestyle modification demonstrated low knowledge level of lifestyle modification. CONCLUSION: This study has shown the existence of obesity and its common primary co-morbidities among the study population. Anthropometric determination of obesity and screening for its common primary comorbidities should be integrated as part of clinic baseline assessment of adult Nigerians attending semi-urban hospitals. Those who had obesity-related primary co morbidities should become secondary target for risk reduction therapy and appropriate management.