Effect of Motivational Interviewing on Lifestyle Modification among Patients with Hypertension Attending the Family Medicine Clinics of ISTH, Irrua, Nigeria (Milmaph Study) - A Randomised Control Trial Study Protocol.

BACKGROUND: Hypertension is a leading cause of morbidity and mortality globally. Over a quarter of patients with hypertension have uncontrolled hypertension. Lifestyle modification has been shown to improve blood pressure control, thus measures that would help patients with hypertension achieve positive lifestyle modification would improve BP control. The study aims to determine the effect of motivational interviews on lifestyle modification and blood pressure control among patients with hypertension attending the Family Medicine Clinics of Irrua Specialist Teaching Hospital (ISTH), Irrua, Nigeria. METHODS: The proposed study will be a randomised control trial (PACTR202301917477205). About 212 adults between 18 and 65 years with hypertension presenting to the Family Medicine Clinics of ISTH will be randomised into intervention and control groups. The intervention group will be given a motivational interview (MI) on lifestyle modification at the start of the study and monthly for 6 months in addition to standard care for the management of hypertension. The control group will be given standard care for the management of hypertension only without MI and seen monthly for 6 months. Both groups will be assessed at baseline and 6 months. At baseline, a qualitative technique will be used to determine the reason for not adopting lifestyle modification. STUDY OUTCOME: The primary outcome shall be lifestyle modification at 6 months while the secondary outcome shall be blood pressure control at 6 months. CONCLUSION: Findings from the study will provide cost-effective ways of blood pressure control and reduction in the disease burden of hypertension in Nigeria.

CONTEXTE: L'hypertension est l'une des principales causes de morbidité et de mortalité à l'échelle mondiale. Plus d'un quart des patients hypertendus ont une hypertension non contrôlée. La modification du mode de vie a été démontrée pour améliorer le contrôle de la pression artérielle, ainsi les mesures qui aideraient les patients hypertendus à réaliser une modification positive de leur mode de vie amélioreraient le contrôle de la PA. L'étude vise à déterminer l'effet des entretiens motivationnels sur la modification du mode de vie et le contrôle de la pression artérielle chez les patients hypertendus fréquentant les cliniques de médecine familiale de l'hôpital spécialisé d'enseignement d'Irrua (ISTH), Irrua, Nigeria. MÉTHODES: L'étude proposée sera un essai contrôlé randomisé (PACTR202301917477205). Environ 212 adultes âgés de 18 à 65 ans atteints d'hypertension se présentant aux cliniques de médecine familiale de l'ISTH seront randomisés en groupes d'intervention et de contrôle. Le groupe d'intervention recevra un entretien motivationnel (EM) sur la modification du mode de vie au début de l'étude et mensuellement pendant 6 mois en plus des soins standard pour la prise en charge de l'hypertension. Le groupe témoin recevra uniquement les soins standard pour la prise en charge de l'hypertension sans EM et sera vu mensuellement pendant 6 mois. Les deux groupes seront évalués au départ et à 6 mois. Au début, une technique qualitative sera utilisée pour déterminer la raison de la non-adoption de la modification du mode de vie. RÉSULTAT DE L'ÉTUDE: Le critère de jugement principal sera la modification du mode de vie à 6 mois, tandis que le critère de jugement secondaire sera le contrôle de la pression artérielle à 6 mois. CONCLUSION: Les résultats de l'étude fourniront des moyens rentables de contrôle de la pression artérielle et de réduction de la charge de morbidité de l'hypertension au Nigeria. MOTS-CLÉS: hypertension, entretien motivationnel, modification du mode de vie, contrôle de la pression artérielle, médecine familiale.

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.

Knowledge and perception of HIV prevention through condom use among midlife and older adults in Calabar, Nigeria.

OBJECTIVES: Older people are at increasing risk of HIV/AIDS and other sexually transmitted diseases. The use of condoms which can protect both partners from sexually transmitted infections (STIs) including HIV during vaginal and anal sex is mostly neglected by them. In fact, postmenopausal women may not see the need for condom use when they are no longer at risk for pregnancy. Even though HIV/AIDS in older patients carry a high mortality, it is many times neglected by even healthcare providers because of the belief that older persons are no longer sexually active. This study aimed to determine the perception and knowledge of condom use as a strategy for HIV/AIDS prevention among midlife and older adults in Calabar Nigeria. METHOD: A cross-sectional study was carried out to identify the perception and knowledge of HIV transmission and condom use among adults over 50 years ofage, in the University of Calabar Teaching Hospital, Calabar, Nigeria. A structured questionnaire was used to get the demographic data, sources of information about the disease, knowledge about the use of condom and its efficacy in preventing the disease. RESULTS: A total of 488 participants were interviewed, comprising 263 males (53.9%) and 225 females (46.1%). Most of them (83.8%) were married and the rest (16.2%) were single. The majority of the respondents (368, 75.7%) got their information about HIV/AIDS transmission and prevention from the television. Other sources of information for respondents on HIV/AIDS were awareness campaigns (43.5%), newspapers (38.6%), friends (37.3%) and neighbours (27.1%). Three hundred and four (62.3%) of the respondents said that they had used condoms and believed that condoms could effectively prevent transmission of STIs including HIV compared to the one hundred and eighty-four (31.7%) who opined otherwise. Abstinence was the major mode of prevention of the disease among respondents while unprotected sexual intercourse was identified by the majority of the respondents (87.5%) as a high risk factor CONCLUSION: There should be more public education on HIV/AIDS to midlife and older adults.

Plasma Fibrinogen Levels of Healthy Non-Pregnant Women in Calabar; South-South Nigeria

In recent years the role of plasma fibrinogen as an independent cardiovascular risk factor has been increasingly recognized. Most of the studies on the relationship between plasma fibrinogen and cardiovascular risk have been in men; with that in women less investigated. Haemostatic and endothelial function in relation to thrombogenesis and CHD may be particularly important in women because women with myocardial infarction and angina chest pain are more often free of angiographically visualized coronary atherosclerosis than are men. This study was to establish the plasma fibrinogen level of adult women seen in the Outpatient Clinic. One hundred non-pregnant women attending the University of Calabar Teaching Hospital General Outpatient Clinic (GOPC) aged between 18-90 years who met the inclusion criteria and gave informed consent were recruited into the study. Each subject had 4.5mls of venous blood sample collected by vene-puncture using a plastic syringe. This was transferred into a tube containing 0.5ml of trisodium citrate (10:1 dilution); this was centrifuged immediately and plasma analysed for fibrinogen concentration by the modified Clauss technique. Comparison between pre-menopausal; peri-menopausal and post-menopausal groups was done by one-way analysis of variance (ANOVA) followed by student's t-test. A p value of less than 0.05 was considered as significant. The fibrinogen concentration (mg/dl) were 257+44; 315+40 and 579+99 for pre-menopausal; peri-menopausal and post-menopausal women respectively (p0.05). ANOVA showed a Critical F-ratio 3.07; calculated df ratio was 220 (p0.05). Collorary to the ANOVA; student t-test of 1.7 (p0.05) between pre-menopausal and peri-menopausal women; pre-menopausal and post-menopausal women 6.2 (p0.05); and peri-menopausal and post-menopausal women 3.5 (0.05). The critical range for student t-test was 12.7; while calculated t ratio was less. The foregoing findings raise a serious concern for Hormone Replacement Therapy (HRT) using estrogens in women with severe symptoms of menopausal syndrome. Although the fattening room practice termed `Nkuho' or `Mbobo' among the Calabar women is on the decline it exposes women of reproductive age to increased cardiovascular risk. It is thus necessary that Primary Care Physicians begin to include plasma fibrinogen estimations as part of cardiovascular risk profiling as a health promotion strategy in all women of reproductive age

Diverse blood exposures associated with incident HIV infection in Calabar, Nigeria.

Few types of blood exposures have been assessed in relation to incident HIV infection in sub-Saharan Africa, despite evidence that penile-vaginal sex cannot account for the epidemic in the region. To investigate correlates of incident HIV infection in Calabar, Nigeria, we surveyed clients at voluntary HIV counselling and testing centres. Participating clients who tested multiple times were generally similar to those testing only once in terms of demographic characteristics, sexual and blood exposures and HIV prevalence. Blood exposures were common. Serial testers had a 10% annual incidence of HIV infection. Seroconverters and seronegative serial testers were similar on most demographic characteristics and sexual exposures. However, seroconverters were more likely than seronegatives to report blood exposures during the test interval, both for most specific exposures as well as summary measures of blood exposures. In particular, seroconverters were substantially more likely to report one of a set of blood exposures that cannot be explained as a consequence of unprotected vaginal sex or of health care for symptoms of HIV infection (adjusted odds ratio = 6.6, 95% confidence interval = 1.2-38). The study design we used is an inexpensive approach for describing the local epidemiology of HIV transmission and can also serve as the foundation for more definitive investigations that employ contact tracing and sequencing of HIV DNA.

Exposure of petrol station attendants and auto mechanics to premium motor sprit fumes in Calabar, Nigeria.

A population-based-cross-sectional survey was carried out to investigate the potential risk of exposure to premium motor spirit (PMS) fumes in Calabar, Nigeria, among Automobile Mechanics (AM), Petrol Station Attendants (PSA) and the general population. Structured questionnaire was administered on the randomly chosen subjects to elicit information on their exposure to PMS. Duration of exposure was taken as the length of work in their various occupations. Venous blood was taken for methaemoglobin (MetHb) and packed cells volume (PCV). Mean MetHb value was higher in AM (7.3%) and PSA (5.8%) than in the subjects from the general population (2.7%). PCV was lower in PSA (30.8%), than AM (33.3%) and the subjects from the general population (40.8%). MetHb level was directly proportional, and PCV inversely related, to the duration of exposure. The study suggested increased exposure to petrol fumes among AM, PSA, and MetHb as a useful biomarker in determining the level of exposure to benzene in petrol vapour.

Treatment of relatives by doctors: experience from Calabar, Nigeria.

OBJECTIVE: To determine the involvement of medical practitioners working in a tropical setting in the treatment of their relatives. DESIGN: Cross-sectional. SUBJECTS: Medical practitioners of all cadres working in the University of Calabar Teaching Hospital, Calabar, Nigeria. SETTING: A large teaching hospital in Calabar, Nigeria. A referral centre for two states. MAIN OUTCOME MEASURES: Extent, type and effect of involvement in the practice. RESULTS: Majority (90.9%) of medical practitioners in our centre were found to have been involved in the treatment of their relatives. Services rendered included consultation, in which all respondents (100%) have partaken. Cardiopulmonary resuscitation (16.9%) and emergency surgery were performed by only a few (3.1%). Though fees were not charged for services provided by most; a few (13.1%) did so. Outcome of involvement was unfavourable in some instances: 9.4% lost relatives they were involved in treating. Majority of the respondents 51.7% believed it is unethical to treat relatives and advocated for only limited involvement. This is because the pressure from relatives for care cannot be entirely ignored. CONCLUSION: It is difficult in our environment not to accede to request to treat family members. We recommend that practitioners may offer only consultation, and in some cases treat minor ailments while referring more serious ones to appropriate colleagues.

The role of mothers in household health-seeking behavior and decision-making in childhood febrile illness in Okurikang/Ikot Effiong Otop community, Cross River State, Nigeria.

The authors examine mothers and decision making during childhood febrile illness in rural Nigeria in this article. Employing a cross-sectional descriptive community survey, we elicited information from four categories of caregivers with the help of structured questionnaires. Apart from sociostructural economic factors, the authors reveal how interlocking objectives and values as expressed in extended family institutions functioned to influence both behavior and decision making of mothers. We suggest expanding the target of health education in the rural areas to include the family as an extended structure.

Human capital flight challenges within an equitable health system.

BACKGROUND: The issue of human capital flight has been discussed at different forums with a consensus opinion that it has its merits and demerits to equitable health system. Most often one nation becomes a substantial net exporter of talent, leaving the provider nation at risk of depleting its natural supply of talent. This paper looks into the historical perspective of human capital flight or "brain drain", and its burden. It attempts to elucidate the various causes and suggested solutions. The paper's objective is to educate colleagues on the conceptual and contextual imperatives of the issue. METHOD: Using a convenient sample of key informants who were medical colleagues in Nigeria relevant information was sourced from these colleagues, documents from the postgraduate medical college of Nigeria and the internet on maters relating to human capital flight and brain drain. RESULTS: Every year, thousands of qualified doctors, and other professionals leave Nigeria tempted by significantly higher wages, brighter prospects for employment and education, stability, food security. CONCLUSIONS: It appears that the potential exposure to different working conditions, resources and professional environments can be of advantage to the country, should Nigeria be able to recall these professionals. It also appears that necessary economic reforms that make staying at home rewarding, that is--good leadership, and policy planning that seriously looks into rural development, among other issues, are keys ingredients to reversing the trend in order to ensure a more equitable health system.

Oil doom and AIDS boom in the Niger Delta Region of Nigeria.

CONTEXT: There has been a steady rise in Nigeria's HIV/AIDS burden since the first sero-prevalence survey in 1991. Nigeria's economy is mainly dependent on oil that comes from the Niger Delta Region. The majority of the people of the Niger delta region depend on fishing and farming for livelihood. Years of oil exploration activities with frequent oil spillages have led to severe environmental degradation with resultant destruction of farmlands and aquatic flora and fauna. The situation of the people of Niger Delta is characterised by poverty, high fertility and disease. ISSUE: Oil has become, to the people of the Niger Delta region a doom that has contributed in no small measure to the AIDS boom in the region. The relationship between such a burden and poverty has been forged by years of official neglect, and the presence of foreign workers. In addition, young Nigerians are drawn to the Niger Delta region by the oil economy, searching for non-existent jobs. Within Nigeria, the states of the Niger Delta region bear the burden of the spread of HIV/AIDS, and the region's poverty amidst plenty, has a negative impact on the population. LESSONS: The article concludes that the HIV/AIDS burden of the region deserves urgent and special attention because it has far-reaching implications, not only for control efforts in Nigeria, but also for the rest of the world, as nationals of various countries find employment in its oil fields. A number of recommendations are made.

STI epidemics in the Indian Ocean region: can the phase be assessed?

The Indian Ocean provides a unique opportunity to curb the HIV epidemic in its nascent phase through strengthening STI control programmes. Making effective and appropriate health services available should be regarded as the first priority for STI control in the region and, whenever possible, core groups should be identified and targeted to interrupt transmission within such networks.