Family Circle and Willingness to Subscribe to Community-based Health Insurance (CBHI) for the Elderly in a Rural Community in South-South Nigeria.

BACKGROUND: The older people in most rural communities depend on family members to provide resources for their healthcare. However, such payments for health services are mostly out of pocket. In trying to protect the health of elderly persons who by nature are prone to high morbidity, other younger family members may be contacted for financial support for their healthcare through contributions to the Community based Health Insurance (CBHI). This study assessed the willingness of the significant other in the family to subscribe to the CBHI for the elderly person within the family. METHODS: A cross-sectional survey was used to study 358 elderly people, and their significant other (identified by using the family circle tool). The respondents were selected by a multistage sampling technique from nine clusters of villages within the community. The data were generated with an interviewer-administered semi-structured questionnaire. For the significant other that lived outside the community phone call was used for the interview. Descriptive and inferential analyses were done using SPSS 22. RESULTS: Majority of the significant others (97.8%) were aged less than 60 years and mostly female (67.9%) and had attained the tertiary level of education (75.4%). Most of the significant others were civil servants (83.0%); 94.7% were Christians; 87.4% were married, and 83.2% lived in urban locations. Only 7.5% were aware of CBHI and 56.7% were willing to buy N10,000 (naira) subscriptions for CBHI. Socio-demographic characteristics that were significantly associated with willingness to subscribe for CBHI were age < 60 years (p=0.040), tertiary education (p<0.001), occupation (p<0.001), religion (p=0.008), marital status (p<0.001), place of residence (p<0.001) and monthly income (p<0.001). CONCLUSION: There is a need to create awareness of CBHI in communities, as the majority of the significant others identified in this study were ready to subscribe to CBHI for the elderly members of their families at a convenient cost.

CONTEXTE: Dans la plupart des communautés rurales, les personnes âgées dépendent des membres de leur famille pour financer leurs soins de santé. Cependant, ces paiements pour les services de santé se font le plus souvent de leur poche. En essayant de protéger la santé des personnes âgées qui, par nature, sont sujettes à une morbidité élevée, d'autres membres plus jeunes de la famille peuvent être contactés pour obtenir un soutien financier pour leurs soins de santé par le biais d'une contribution à l'assurance maladie communautaire (CBHI). Cette étude a évalué la volonté de l'autre membre de la famille de souscrire à l'assurance maladie communautaire pour la personne âgée de la famille. MÉTHODES: Une enquête transversale a été menée auprès de 358 personnes âgées et de leur proche (identifié à l'aide de l'outil du cercle familial). Les personnes interrogées ont été sélectionnées par une technique d'échantillonnage à plusieurs degrés dans neuf groupes de villages au sein de la communauté. Les données ont été générées à l'aide d'un questionnaire semi-structuré administré par un enquêteur. Pour la personne significative qui vivait en dehors de la communauté, un appel téléphonique a été utilisé pour l'entretien. Les analyses descriptives et inférentielles ont été effectuées à l'aide de SPSS 22. RÉSULTATS: La majorité des personnes interrogées (97,8 %) étaient âgées de moins de 60 ans, principalement des femmes (67,9 %) et avaient atteint un niveau d'éducation supérieur (75,4 %). La plupart des personnes interrogées étaient des fonctionnaires (83 %), 94,7 % étaient chrétiennes, 87,4 % étaient mariées et 83,2 % vivaient en milieu urbain. Seuls 7,5 % connaissaient l'existence de la CBHI et 56,7 % étaient prêts à souscrire un abonnement de 10 000Naira pour la CBHI. Les caractéristiques sociodémographiques significativement associées à la volonté de souscrire un abonnement à la CBHI étaient l'âge < 60 ans (p=0,040), l'enseignement supérieur (p<0,001), la profession (p<0,001), la religion (p=0,008), la situation matrimoniale (p<0,001), le lieu de résidence (p<0,001) et le revenu mensuel (p<0,001). CONCLUSION: Il est nécessaire de sensibiliser les communautés à l'initiative CBHI, car la majorité des proches identifiés dans cette étude étaient prêts à souscrire à l'initiative CBHI pour les membres âgés de leur famille à un coût raisonnable. Mots-clés: Cercle familial, Volonté, Assurance maladie communautaire, Personnes âgées, Communauté rurale.

Impact of diabetes mellitus on sexuality in a developing country setting: A case-control study in Calabar, Nigeria.

BACKGROUND: This study aimed to identify the unmet sexual health needs of the patients with diabetes seen in a tertiary healthcare facility in Nigeria. METHODS: Case-control study design and random sampling method were utilized to recruit type 2 diabetic cases from the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria. Female Sexual Function Index (FSFI) and International Index for Erectile Function (IIEF) were used to assess sexual function. RESULT: There were 330 subjects with the mean age of 54.9 years. Among females, the FSFI score was lower among cases compared with controls (18.8 vs. 23.1, P < 0.05). Except for sexual interest, mean scores for all other domains of sexual function were also lower among cases (P < 0.05). Among males, there was no significant difference in overall mean IIEF score comparing cases and controls (40.0 vs. 41.7, P > 0.05). However, mean scores for desire and satisfaction was lower among cases compared with controls (P < 0.05). Older age, unmarried status, presence and duration of hypertension were associated with sexual dysfunction among females. The use of supplements was associated with sexual dysfunction among males (P < 0.05). CONCLUSION: Sexual dysfunction is common among diabetics with variation in affected domains in both genders in the study setting. These unmet sexual health needs focus to be addressed.

Use of the General Health Questionnaire as a screening tool for geriatric patients in Calabar, Nigeria.

BACKGROUND: Old age is inevitably associated with general biological and physical decline.Mental health issues are among the most prevalent health problems of the elderly and constitute an important source of distress for patients and caregivers. Primary care providers frequently fail to diagnose these problems, and, even when they do, management may not be optimal. This study aimed to determine the proportion of geriatric mental health morbidity detected by Family Physicians and compare this with General Health Questionnaire detection in the recognition ofmorbidity in this cohort. METHOD: This was a cross-sectional descriptive survey involving 107 elderly respondents, conveniently recruited for the study from the Family Medicine Geriatric Clinic of the University of Calabar Teaching Hospital, Calabar. Respondents were grouped into 'cases' and 'non-cases' using a cut-offscore of'3' with the General Health Questionnaire as the main comparative detection instrument. Family Physicians' abilities to identify mental health morbidity were then compared with the General Health Questionnaire ratings. Socio-demographic correlates and identification rates were determined by statistical tests of associations. RESULTS: The General Health Questionnaire identified 48.6% 'cases' while the Family Physicians identified 9.4% among the attendees. Statistically significant differences in socio-demographic characteristics of respondents were found for marital status (chi2 = 21.84; p< 0.009), level of education (chi2 = 42.58; p<0.005) and sex chi2 = (6.98; p<0.008). CONCLUSION: This study concludes that using the General Health Questionnaire and paying attention to geriatrics' socio-demographic parameters can improve the detection of mental health morbidities in the elderlyby Family Physicians.

Recognition of mental health problems by primary care physicians in a tertiary care hospital in Nigeria.

AIMS AND OBJECTIVES: This study sought to determine the difference in detection of attendees with mental health problems visiting the General Out-patient clinic of a tertiary institution; the General Health Questionnaires (GHQ-12) were compared with those identified by the physicians. PATIENTS AND METHODS: Three hundred and twenty two (322) subjects aged 18 years and above, attending the clinic for the first time, were recruited for the study by a systematic random sampling method. Using a cut off score of '3' on the 12-item General Health Questionnaire (GHQ-12), 'Cases' and 'Non-cases' generated were compared with those identified by the doctors. Identification rates for both groups were calculated and the coefficients determined using a two-by-two contingency table. RESULTS: The GHQ-12 identified 46.6% 'cases' while the General Out-patient Clinic (GOPC) doctors identified 6.8% with a diagnostic sensitivity of 8% and a specificity of 94% CONCLUSION: Despite the high proportion of mental health problems in the GOPC of the hospital, the detection rate by the clinic doctors was low. There is a need for the use of an easy tool like the GHQ-12 for screening and identification of attendees with mental health problems especially in a busy clinic setting.