Patient-Doctor relationship in underserved environment: A cross-sectional study of attitudinal orientation, practice inclination, barriers and benefits among medical practitioners in Abia State, Nigeria.

BACKGROUND: Healthcare has become complex requiring balance of ever-increasing demands on physicians against humanness of medicine. As the impetus for the delivery of patient-centred care grows, there is need to study the attitude and practice orientations of medical practitioners to patient-doctor relationship (PDR). The study was aimed at describing the attitude, practice, barriers and benefits of PDR among medical practitioners in Abia State. PARTICIPANTS AND METHODS: A descriptive cross-sectional study was carried out on 210 medical practitioners in Abia State who were consecutively recruited for the study. Data were collected using self-administered questionnaire that elicited information on attitude, practice, barriers and benefits of PDR. Attitude was assessed with the 18-item Patient-Practitioner Orientation Scale (PPOS) with subscales of caring and sharing. RESULTS: The age of the participants ranged from 26 to 77 years with the mean of 36 ± 8.4 years. There were 173 (82.4%) male. The caring attitude score (mean = 3.57 ± 0.80) was higher than sharing (mean = 3.42 ± 0.65) (P = 0.036). Practice was predominantly doctor-centred (86.7%) than patient-centred (64.3%, P < 0.0001). The most common barrier to PDR was patient-doctor communication, while the most common benefit of PDR was improvement in patient satisfaction. Medical practitioners with duration of practice <10 years had significantly higher mean scores in attitudinal subscale of caring when compared with those with duration of practice ≥10 years (P < 0.0001). The study participants with duration of practice ≥10 years had significantly higher adequate practice (75.0%) of patient-centred care when compared with their counterparts with duration of practice <10 years (47.6%) (P = 0.00005). CONCLUSION: The attitude to caring did not translate to comparative disposition to sharing. The practice was more doctor-centred than patient-centred. The most common barrier and benefit of PDR were communication drawbacks and improvement in patient satisfaction, respectively. Duration of practice was associated with caring attitude and practice of patient-centred care, respectively.

Mentoring in a resource-constrained context: A single-institutional cross-sectional study of the prevalence, benefits, barriers and predictors among post-graduate medical college fellows and members in South-Eastern Nigeria.

BACKGROUND: Globally, the post-graduate medical education has undergone tremendous changes with emphasis on training, services and research to equip trainees with competence for independent professional development. However, not all the fellows and members of the West African Post-graduate Medical College and the National Post-graduate Medical College of Nigeria recognise the values of mentoring in achieving the career success. AIM: The study was aimed at describing the prevalence, benefits, barriers and predictors of mentoring in a cross-section of the Post-graduate Medical College fellows and members in a tertiary health institution in South-Eastern Nigeria. PARTICIPANTS AND METHODS: A cross-sectional study was carried out among 168 study participants who were sampled from the Post-graduate Medical College fellows and members in the Federal Medical Centre, Umuahia, Nigeria. Data collection was done using a pre-tested, self-administered questionnaire that elicited information on awareness, prevalence, barriers and benefits of mentoring. RESULTS: The age of participants ranged from 26 to 59 (41 ± 9.4) years. All the respondents were aware of the mentorship. The prevalence of mentoring was 33.3%. The most common benefit was personal and professional growth and development (100.0%). The most common barrier was the pressure of professional duties and personal exigencies (100.0%). The most significant predictor of mentoring had departmental mentoring programme participants who had departmental mentoring programmes were two times more likely to have mentoring relationships when compared to their counterparts who had none (adjusted odds ratio = 2.32; 95% confidence interval: 1.20-3.10; P = 0.002). CONCLUSION: The level of awareness of mentoring was very high but did not translate to appropriate involvement in mentoring. The most common benefit was personal and professional growth and development. The most common barrier was the pressure of professional duties and personal exigencies. The most significant predictor of mentoring relationship had departmental mentoring programme.

Depression among ambulatory adult patients in a primary care clinic in southeastern Nigeria.

BACKGROUND: Depression is a global health problem that occupies eminent position in clinical and community mental health. As the global prevalence of depression increases, the sociomedical challenges associated with it increase, especially in resource-constrained environment. AIM: The study was aimed at describing depression among ambulatory adult patients in a primary care clinic in Southeastern Nigeria. PATIENTS AND METHODS: A cross-sectional descriptive hospital-based study was carried out on 400 adult patients in a primary care clinic of Federal Medical Centre, Umuahia. Data on relevant epidemiological variables were collected using pre-tested, structured interviewer-administered questionnaire. Patient Health Questionnaire-9 was used to assess for depression. Data were analysed using the Statistical Package for the Social Sciences software version 21. Test of associations was done using Chi-test and logistic regression, and P < 0.05 was considered statistically significant. RESULTS: The age of the study participants ranged from 18 to 78 years with mean age of 38 ± 9.2 years, and there were 40.5% males. The prevalence of depression was 48.5% with the most common type being mild depression (32.3%). Occurrences of symptoms were most frequent and severe in the home environment (59.8%) and during the night (62.9%). Hypertension (35.5%) and alcohol use (57.5%) were the most common medical condition and substance used, respectively. Depression was significantly associated with elderly age (P = 0.005), females (P = 0.017), physical inactivity (P = 0.039) and psychosocial stressors (P = 0.042). The most significant predictor of depression was elderly age (adjusted odds ratio = 2.50; 95% confidence interval [1.40-3.78]; P = 0.001). Older persons were three and half times more likely to have depression when compared to their counterparts who were younger. CONCLUSION: This study has demonstrated high prevalence of depression and some epidemiological factors in the occurrence of depression among the study participants. Depression occurred predominantly among the elderly, females, physically inactive, hypertensive and those who had psychosocial stressors. Occurrences of symptoms were most frequent at home and nighttime. The most commonly used substance was alcohol.

Sero-epidemiology of Hepatitis B Surface Antigenaemia among Adult Nigerians with Clinical Features of Liver Diseases Attending a Primary-Care Clinic in a Resource-Constrained Setting of Eastern Nigeria.

BACKGROUND: Hepatitis-B infection is not commonly perceived as a serious medical problem in Nigeria. However, chronic hepatitis-B infection, which is a subject of global concern, may lead to lethal liver diseases. AIM: The study was to determine the sero-epidemiology of hepatitis-B surface antigenaemia among adult Nigerians with clinical features of liver diseases attending a primary-care clinic in a resource-constrained setting of Eastern Nigeria. MATERIALS AND METHODS: A cross-sectional study was carried out on 140 adult Nigerians with clinical features of liver diseases at the primary-care clinic of Federal Medical Centre, Owerri. They made up three groups: 44 patients, 62 patients and 34 patients with clinical features of hepatitis, liver cirrhosis and hepatocellular carcinoma, respectively. Hepatitis-B surface antigen (HBsAg) was assayed using an immunochromatographic method. Demographic variables were collected. RESULTS: The overall sero-positivity rate was 50.7%. The sero-positivity rates for these patients were 23.9%, 39.5% and 36.6% for hepatitis, liver cirrhosis and hepatocellular carcinoma, respectively. The age group 40-60 years (P = 0.048) and artisans (P = 0.019) were significantly infected. Abdominal swelling (86.4%) and ascites (67.1%) were the most common symptoms and signs, respectively. CONCLUSION: HBsAg prevalence was high and has significant association with age and occupation.

Obesity and Its Cardio-metabolic Co-morbidities Among Adult Nigerians in a Primary Care Clinic of a Tertiary Hospital in South-Eastern, Nigeria.

BACKGROUND: Obesity once thought the medical problem of affluent countries now exist in Nigeria and has been described as a time bomb for the future explosion in the frequency of cardio-metabolic diseases. The most deleterious health consequences of obesity are on the cardiovascular system and associated disorder of lipid and glucose homeostasis. AIM: This study was designed to determine the magnitude of obesity and its cardio-metabolic co-morbidities among adult Nigerians in a primary care clinic of a tertiary hospital South-Eastern, Nigeria. MATERIALS AND METHODS: A cross-sectional study carried out on 2391 adult Nigerians who were assessed for obesity using body mass index (BMI) criterion. 206 patients who had BMI ≥30kg/m(2) were screened for cardio-metabolic co-morbidities. The data collected included basic demographic variables, weight, height, blood pressure; fasting plasma glucose and lipid profile. RESULTS: The prevalence of obesity was 8.6%. Grade I obesity (67.5%) was the most common pattern; others included grade II obesity (23.3%) and grade III obesity (9.2%). Hypertension (42.7%) was the most common cardio-metabolic morbidity. Others included low HDL-cholesterol (22.8%), diabetes mellitus (15.1%), high triglyceride (12.6%), high total cholesterol (9.2%), and high LDL-cholesterol (6.8%). CONCLUSION: Obesity and its cardio-metabolic morbidities exist among the study population. Anthropometric determination of obesity and screening for its associated cardio-metabolic co-morbidities should constitute clinical targets for intervention in primary care clinics.

Proximate Family Biosocial Variables Associated with Severe Malaria Disease among Under-Five Children in Resource-Poor Setting of a Rural Hospital in Eastern Nigeria.

BACKGROUND: Malaria threatens the life of under-five in rural Nigerian families. Although, factors that influence malaria in under-five are manifold. However, family biosocial factors may contribute to the variability of the clinical picture. AIM: To determine proximate family biosocial variable associated with severe malaria among under-five children in a resource-poor setting of a rural hospital in Eastern Nigeria. MATERIALS AND METHODS: A cross-sectional study carried out on the families of under-five managed for malaria. Data extracted included family biosocial variables and diagnosis. An under-five child was defined to have malaria if the mother gave complaints of fever, vomiting, and other symptoms suggestive of malaria, had body temperature exceeding 37.5°C with the asexual forms of Plasmodium falciparum detected on the peripheral blood film. Severe malaria is the malaria that presents with life-threatening features like severe anemia and cerebral malaria. RESULTS: The prevalence of severe malaria was 31.8% The family biosocial variables significantly associated with severe malaria were maternal low level of education (P = 0.031), family size >4 (P = 0.044), low social class of the family (P = 0.025), nonliving together of parents (P = 0.011), and poor access to health facilities (P = 0.038). The most significant predictor of severe malaria was nonliving together of parents (P = 0.000, odds ratio = 3.08, confidence interval = 1.64-5.10). CONCLUSION: This study has demonstrated that some family biosocial variables are associated with severe malaria. These families should constitute at risk families that could be targeted for malaria interventional programs.