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.

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.

Orthopaedic infuries in the elderly: Federal Medical Center, Umuahia experience

Background: The elderly constitute an important part of the general population. Worldwide the population of the elderly has increased over the years. This paper documents the pattern of orthopaedic injuries in the elderly in Umuahia; Nigeria. Methods: A retrospective study of all injuries in patients aged 60years and above seen at the Federal Medical Centre; Umuahia from 1st July; 1996 to 30th June; 1999 utilizing data from the patients' case notes; casualty and ward registers are well as the theatre registers. Extracted data was analyzed using descriptive statistics. Results: Of the 102 patients seen; only 62 patients' records were retrievable. There were 38 males and 24 females giving a male: female ratio of 1.6:1. Their average age was 68.7 years. Over 60were in the 60-69 years age bracket. Most of the injuries occurred in the rural setting. The most common aetiology was road traffic accidents(54.8) followed by falls (21.0). Most patients (69.4) presented within 7 days of injury with 27.4receiving some form of treatment before presentation. The most common body region affected was the lower limb followed by the upper limb. Fractures were the most common injury type. The most common comorbidity was hypertension followed by arthritis and diabetes mellitus. The average duration of hospital stay was 20.7 days. No mortality was recorded. While 45.2were discharged on recovery; 22.6discharged against medical advice. Conclusion: Trauma-related injuries in the elderly are not uncommon and road traffic accident was the most common aetiology. Efforts should be made to prevent these injuries