PROFILES AND PREDICTORS OF SUBJECTIVE WELL-BEING AND HEALTH-SEEKING BEHAVIOUR AMONG OLDER PERSONS WITH MULTIMORBIDITY IN A RURAL PRIMARY CARE ENVIRONMENT IN SOUTH-EASTERN NIGERIA.

Background: Subjective well-being(SWB) and health-seeking behaviour(HSB) are important medical channels to gauge the health status of older persons with multimorbidity particularly in resource-poor environment with limited socio-medical and health infrastructure. Aim: The aim of the study was to determine the profiles and predictors of SWB and HSB among older persons with multimorbidity in a rural primary care environment in South-Eastern Nigeria. Methods: A cross-sectional study was conducted on 214 older persons with multimorbidity from January to December 2022 in South-Eastern Nigeria. Data collection was done using structured, pretested and interviewer guided questionnaire. Subjective well-being was determine using single-item self-rated health status questionnaire. Multimorbidity was determine using Multimorbidity Assessment Questionnaire for Primary Care(MAQ-PC). Results: The ages of study participants were 60-99 years(x=68±4.5 years). There were 123(57.5%) females. Ninety-three (43.5%) of the study participants had good SWB while 86(40.2%) had appropriate HSB. The most common multimorbidities were aggregate disorders of cardiovascular, musculoskeletal and gastrointestinal systems. The independent predictors of poor SWB were advanced old age(ORs=3.101; 95%CI(1.526-6.019); P=.024), low education(ORs=4.056; 95%CI(2.512-8.509); P=.025) and non-household family structure(ORs=2.225; 95%CI(1.078-6.192); P= .001). Inappropriate HSB were predicted by males(ORs=2.428; 95%CI(1.107-6.379); P=.039), low education(ORs=3.007; 95%CI(1.387-7.001); P=.013) and retirees with no secondary occupation (ORs=4.761;95%CI(1.351- 8.072); P= .001). Conclusion: The study has shown the SWB and HSB among the study participants. The independent predictors of poor SWB were advanced old age, low education and non-household family structure. Inappropriate HSB werepredicted by males, low education and retirees with no secondary occupation. Subjective well-being and HSB should be explored during clinical consultations with older persons with multimorbidity particularly in the sub-region with double whammy of non-communicable and communicable diseases.

Satisfaction with Quality of Care Received by Patients without National Health Insurance Attending a Primary Care Clinic in a Resource-Poor Environment of a Tertiary Hospital in Eastern Nigeria in the Era of Scaling up the Nigerian Formal Sector Health Insurance Scheme.

BACKGROUND: The increasing importance of the concept of patients' satisfaction as a valuable tool for assessing quality of care is a current global healthcare concerns as regards consumer-oriented health services. AIM: This study assessed satisfaction with quality of care received by patients without national health insurance (NHI) attending a primary care clinic in a resource-poor environment of a tertiary hospital in South-Eastern Nigeria. SUBJECT AND METHODS: This was a cross-sectional study carried out on 400 non-NHI patients from April 2011 to October 2011 at the primary care clinic of Federal Medical Centre, Umuahia, Nigeria. Adult patients seen within the study period were selected by systematic sampling using every second non-NHI patient that registered to see the physicians and who met the selection criteria. Data were collected using pretested, structured interviewer administered questionnaire designed on a five points Likert scale items with 1 and 5 indicating the lowest and highest levels of satisfaction respectively. Satisfaction was measured from the following domains: patient waiting time, patient-staff communication, patient-staff relationship, and cost of care, hospital bureaucracy and hospital environment. Operationally, patients who scored 3 points and above in the assessed domain were considered satisfied while those who scored less than 3 points were dissatisfied. RESULTS: The overall satisfaction score of the respondents was 3.1. Specifically, the respondents expressed satisfaction with patient-staff relationship (3.9), patient-staff communication (3.8), and hospital environment (3.6) and dissatisfaction with patient waiting time (2.4), hospital bureaucracy (2.5), and cost of care (2.6). CONCLUSION: The overall non-NHI patient's satisfaction with the services provided was good. The hospital should set targets for quality improvement in the current domains of satisfaction while the cost of care has implications for government intervention as it mirrors the need to make NHI universal for all Nigerians irrespective of the employment status.

The magnitude of abdominal adiposity and atherogenic dyslipidemia among geriatric Nigerians with arterial hypertension in a rural hospital in South-eastern Nigeria.

BACKGROUND: As the case detection rate of arterial hypertension increases daily in rural Nigeria, screening for its associated abdominal obesity and dyslipidemia is an important healthcare challenge. Of great concern in rural Nigeria is that most geriatric hypertensives with abdominal obesity and dyslipidemia are not routinely diagnosed and therefore do not receive appropriate management. OBJECTIVE: This study was aimed at describing the magnitude (prevalence and pattern) of abdominal adiposity using waist circumference (WC) index and dyslipidemia among geriatric Nigerians with arterial hypertension in a rural hospital in South-eastern Nigeria. MATERIALS AND 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. Abdominal obesity was defined as WC ≥102 cm and ≥88 cm for men and women, respectively. Dyslipidemia was defined using the third report of National Cholesterol Education Panel in adult (ATP III). The data collected included basic demographic variables, blood pressure, waist circumference, fasting lipid profile, and blood sugar. RESULTS: The prevalence of abdominal obesity was 50.8% and was the most common pattern of abdominal adiposity. Fifty-four (44.3%) out of 122 patients had at least one dyslipidemia with the most frequent being low high-density lipoprotein cholesterol (HDL-C, 38.5%). There was statistically significant difference between male and female gender based on abdominal adiposity (X 2 = 5.406, P value = 0.04) while their mean lipid differentials were not statistically significant. CONCLUSION: This study has shown that abdominal adiposity and dyslipidemia exist among geriatric hypertensives in the study area with abdominal obesity being the most common abdominal adiposity and low HDL-C being the most frequent lipid abnormality. This study therefore urges the necessity to consider abdominal obesity and dyslipidemia in geriatric hypertensives in rural Nigeria alongside the complex of other cardiovascular risk factors.

Common geriatric emergencies in a rural hospital in South-Eastern Nigeria.

BACKGROUND: Geriatric population in rural Nigeria is often challenged by emergency health conditions that predispose them to higher risk of disability and mortality. OBJECTIVE: This study was aimed at describing the common geriatric emergencies in a rural hospital in South-Eastern Nigeria. MATERIALS AND METHODS: This was a descriptive hospital-based study of 216 geriatric patients who presented between June 2008 and June 2011 with emergency health conditions at St Vincent De Paul hospital, Amurie-Omanze, a rural Mission General Hospital in Imo state, South-Eastern Nigeria. The geriatric patients seen within the study period who met the selection criteria were studied. Data extracted for analysis included biodata and diagnosis made. RESULTS: A total of 216 geriatric emergencies were seen during the study period. The ages of the patients ranged from 65 years to 98 years with mean age of 72 ± 1.14 years. There were 94 males and 122 females with a male to female ratio of 1: 1.3. The three most common causes of geriatric emergencies were acute malaria (33.8%), hypertensive crises syndrome (19.0%), and acute hypertensive heart failure (18.1%). CONCLUSION: This study has shown that the three most common geriatric emergencies were medical emergencies (acute malaria, hypertensive crises syndrome, and acute hypertensive heart failure). Improving the quality of geriatric medical care will help in reduction of these emergency medical conditions. Similarly, health education of the geriatric population to embrace early health-seeking behavior, health maintenance, and promotional practices that are needed to promote longevity is invariably advocated.

Obesity in adult Nigerians: a study of its pattern and common primary co-morbidities in a rural Mission General Hospital in Imo state,South-Eastern Nigeria.

OBJECTIVES: This study was generally aimed at determining the prevalence and pattern of obesity using body mass index (BMI) criterion and specifically screening for its common primary co-morbidities among adult Nigerians attending a rural Mission General Hospital in Imo state, South-Eastern Nigeria. MATERIALS AND METHODS: A descriptive study was carried out from June 2008 to May 2009. A total of 2156 consecutive new adult patients aged 18-90 years were screened for obesity using the BMI criterion, and 129 patients had BMI ≥ 30 kg/m² and met the inclusion criteria. The data collected included age, sex, marital status, education, occupation, social class, weight, height and blood pressure, fasting blood sugar and lipid profile. RESULTS: The prevalence of obesity was 6.0%, with class I obesity (86.1%) being the most common pattern. Hypertension (16.3%) was the most common primary co-morbidity; others included low high-density lipoprotein-cholesterol (21.7%), high low-density lipoprotein-cholesterol (9.3%), high total cholesterol (7.8%), high triglyceridemia (4.7%) and diabetes mellitus (3.9%). CONCLUSIONS: This study has shown that obesity and its primary co-morbidities are emerging as a serious health problem among the study population, with class I obesity being the most common pattern and hypertension being the most common primary co-morbidity. Anthropometric determination of obesity and screening for its common primary co-morbidities should be integrated as part of the clinic baseline assessment of adult Nigerians attending rural hospitals to facilitate their early detection and institutionalization of appropriate preventive and therapeutic measures.