Perceived Family Support and Medication Adherence amongst Hypertensive Outpatients in a Tertiary Hospital, Ibadan, Nigeria.

BACKGROUND: Adherence to medications is a primary determinant of treatment effectiveness and studies have shown that the level of adherence is positively correlated with treatment outcomes in patients with chronic diseases. Besides, an association has been reported to exist between family support and good health outcome. Determining the relationship between medication adherence and family support will assist physicians in offering holistic care to patients with hypertension. OBJECTIVE: To determine the relationship between family support and adherence to drug treatment amongst hypertensive outpatients in a family practice in Ibadan. METHOD: This was a prospective cross-sectional study. Atotal of 390 outpatients aged 18years and above with hypertension at the Family Medicine Clinic, University College Hospital, Ibadan (UCH) were recruited randomly for 3months. Participants' data were obtained through a semi-structured interviewer-administered questionnaire. The data was analyzed using bivariate analysis and significant variables were analyzed using logistic regression. RESULT: The medication adherence rate was 42.6%. Participants with perceived strong family support (97%), older age (55.6%), and with the diagnosis of disease of more than 10years (54.4%) adhered better to medication in this study. CONCLUSION: The medication adherence amongst patients with hypertension still remain low and Family support is an important positive factor, hence, involvement of family members in treatment is sacrosanct. Furthermore, the physician should use every encounter to counsel younger patients with hypertension and with lesser years of diagnosis on the benefits of medication adherence.

Factors associated with sarcopenia among older patients attending a geriatric clinic in Nigeria.

CONTEXT: Aging is characterized by progressive and generalized loss of skeletal muscle mass and strength called sarcopenia which causes poor health and disability. There is paucity of data on this syndrome of public health importance among older Nigerians. AIM: This study determined the prevalence and factors associated with sarcopenia among persons aged 60 years and above at a geriatric center in Nigeria. MATERIALS AND METHODS: A cross-sectional study of 642 persons aged ≥60 years who attended the geriatric center between March and July 2014. Sarcopenia was diagnosed using the European Working Group on Sarcopenia in Older People criteria. Bivariate and multivariate analyses were carried out using SPSS 20. Alpha was set at 0.05. RESULTS: The mean age ± standard deviation of the respondents was 69.1 ± 7.2 years, and 378 (60.6%) were females. The point prevalence of sarcopenia was 5.4% which was significantly higher among the females compared with the males (7.1% vs. 2.8%) P = 0.02. Low muscle mass and low gait speed were found in 10.9% and 36.1%, respectively. Logistic regression analysis showed age (odds ratio [OR] =1.090; 95% confidence interval [CI] =1.034-1.149, P = 0.01), having no formal education (OR = 2.810; 95% CI = 1.043-7.573, P = 0.04), malnutrition (OR = 5.817; 95% CI = 1.471-23.434, P = 0.01), and female gender (OR = 3.068; 95% CI = 1.068-8.817, P = 0.04) to be the predictors of sarcopenia. CONCLUSION: Older people in this setting are at risk of developing sarcopenia, especially the females. Healthcare workers should address the social and health-related factors which could lead to sarcopenia.

Histopathological alterations, biochemical responses and acetylcholinesterase levels in Clarias gariepinus as biomarkers of exposure to organophosphates pesticides.

Organophosphate pesticides, commonly used in large scale farming, have been found to be major contaminants in aquatic environment. Clarias gariepinus was exposed to acute and sublethal concentrations of phostoxin and DD Force to evaluate single and joint action toxicity of the organophosphates. Effects of phostoxin and DD force on antioxidant enzymes, fish organs and acetylcholinesterase levels in fingerlings and juveniles of C. gariepinus were also investigated. The lethal concentrations (96 h LC50) for phostoxin and DD Force were 0.631 and 1.759 mg/l, respectively. The results obtained from the bioassay showed that phostoxin was 2.8× more toxic than DD Force after exposure of C. gariepinus. Joint action toxicity evaluations of phostoxin and DD Force showed that the interaction between the chemicals was synergistic (RTU >1). The biochemical responses in the exposed fish differed significantly (P < 0.05) from the control fish. The result of acetylcholinesterase study revealed significant difference between acetylcholinesterase levels in the exposed fish and control, with reduction in the acetylcholineterase level in fish exposed to sublethal concentrations of phostoxin and DD Force. Haematological studies revealed an increase in WBC, RBC, PCV and platelets in the exposed fish. Histopathology of the gills showed shortened primary lamellae, loss of secondary lamellae and loss of ceratobrachial bones. In the acute toxicity studies, respiratory stress, erratic swimming and instant death of fish were observed in the exposed fish. This study reveals that changes in histopathology and acetylcholinesterase level are good biomarkers and can be successfully used to detect exposure to organophosphates pesticides in fish.

Functional health of patients with knee osteoarthritis in a family medicine clinic in Ibadan.

BACKGROUND: Patients with knee osteoarthritis experience pain and functional impairment, which impacts upon activities of daily living ultimately leading to a loss of functional independence and low quality- of-life. This study therefore aimed at evaluating the functional health status of patients with knee osteoarthritis in the Family Medicine clinic, University College Hospital, Ibadan, Nigeria. METHODS: A cross-sectional study was conducted on 270 eligible respondents between January and March 2011. The Ibadan Knee/Hip Osteoarthritis Measure (IKHOAM) was administered after screening with the knee pain screening tool (KNEST). Respondents'Socio- demographic characteristics and knee pain intensity ratings were also recorded. RESULTS: The age range of respondents in the study was from 28 years to 85 years with a female: male ratio 5:1. Out of the 270 respondents studied, 146 (54.1%) reported restriction in performing duties at work. One hundred and twenty seven respondents (47.0%) needed some assistance in walking outside the house for 15 to 20 minutes, whilst 195 (72.2%) required some assistance in climbing stairs. Thirty four (12.6%) of Muslims and 77 (28.5%) of Christians could not kneel to pray. Males are twice more likely to have a better functional health than females (OR= 2.1, 95% CI= 1.0- 4.6, p=0.046). CONCLUSION: Knee osteoarthritis significantly impairs activities of daily living, especially some socio-cultural and religious practices of respondents. Therefore in addition to treating the knee symptoms, removing environmental barriers may reduce immobility within and outside the home thereby improving functionality.

ASSESSMENT OF THE LIVING CONDITIONS OF RURAL BASED PEOPLE LIVING WITH HIV/AIDS WITH CLINICAL PRESENTATIONS IN NIGERIA.

OBJECTIVE: To describe the living conditions of rural based people living with HIV/AIDS (PLWHA) and their clinical presentations DESIGN: descriptive cross-sectional study, SETTING: University College Hospital, Ibadan. SUBJECTS: PLWHA on anti-retroviral therapy. RESULTS: One hundred and fifty PLWHA participated. The mean age of the respondents was 28.7 ± 8.9 years. Majority of the respondents visited had advanced disease (97%), were poor (75%) and presented with opportunistic infections such as oral candidiasis (92%), chronic diarrhoea (70%) and pulmonary tuberculosis (46%). Majority were treated for malaria (72%) and anaemia (61%). All respondents lived in homes predisposed to these opportunistic infections. They drink unsafe water and had poor disposal of their domestic wastes. CONCLUSION: PLWHA visited lived in homes that predispose them to various opportunistic infections. Improved living conditions and economic empowerment will improve the health conditions of PLWHA.

Cocos nucifera L. water improves reproductive indices in Wistar Rats.

BACKGROUND: This study explored the effects of Cocos nucifera L. water (CW) on the hypothalamo-pituitary-gonadal axis (HPG) and fertility in Wistar rats. METHODS: Adult male and female Wistar rats were treated orally as follows; Study 1: Group 1: control (distilled water), group 2: 20 ml/kg corn oil (danazol vehicle), group 3: 20 ml/kg CW, group 4: 40 ml/kg CW, group 5: danazol, group 6: danazol + 20 ml/kg CW and group 7: danazol + 40 ml/kg CW. 200 mg/ kg danazol was administered. Serum levels of LH, FSH, estradiol and testosterone; gonadal weights and sperm indices were assessed. Study 2: Group 1: control (distilled water), group 2: 20 ml/kg CW, group 3: 40 ml/kg CW for 6 and 2 weeks prior to mating in male and female rats respectively. RESULTS: Significant (p < 0.05) increases in estradiol concentration were observed in groups 3, 4, 6 and 7. Significant reductions in LH, FSH, estradiol and testosterone levels were observed in group 5 which were ameliorated in groups 6 and 7. Males showed significant increases in sperm count and motility in groups 3, 4, 6 and 7, and reductions in these variables along with viability in group 5. CW pre-treatment increased fecundity index and proportion of female pups from dams, while the pups from sires showed higher birth weights. CONCLUSIONS: CW acts on the HPG to positively influence reproductive function in both males and females and may aid in maternal preconception sex selection of female offspring.

Socio demographic and clinical correlates of knee pain in adult women attending a primary care clinic.

AIMS AND OBJECTIVES: The objectives of the study were to determine the socio demographic and clinical correlates of knee pain in women in a primary care clinic. PATIENTS AND METHODS: The study was a cross-sectional survey of 400 women attending the General Outpatients' clinic of the University College Hospital (U.C.H.), Ibadan, Nigeria using the systematic random sampling technique. RESULTS: The prevalence of knee pain was 42.0% (95% CI 40.0- 41.0). The radiographic findings in the knees showed mostly osteophytes in 24 out of the 28(85.7%) respondents who had radiographs done. The highest prevalence of knee pain was found in caterers and traders, 62.5% and 51.6%, respectively (p= 0.001). Multivariate analysis done using logistic regression with a backward selection showed that the odds of developing knee pain increases with age (Odds Ratio=1.585, 95% CI 1.321-1.903, p=0.000), and body mass index (Odds Ratio 1.587, 95% CI 1.295-1.946, p=0.000). CONCLUSION: The prevalence of knee pain in women seen at the primary care clinic is high. Preventive measures for knee pain need to be instituted.

Visual morbidities among elderly patients presenting at a primary care clinic in Nigeria.

BACKGROUND: Visual challenges compromise mobility, increase dependency on family members and constitute a major health problem mainly seen by the primary care physicians among the elderly. However, there is little information on the pattern of visual problems of elderly patients attending the primary care clinics in Nigeria. OBJECTIVE: To describe the visual problems among elderly subjects in a hospital setting. METHODS: Five hundred consecutive patients (311 females and 189 males) aged 60 years and above were interviewed using a structured questionnaire based on the World Organization of Family Doctors (Wonca) format between September 2004 and April 2005. The main outcome measurements were sociodemographic characteristics, visual acuity and ocular problems. RESULTS: The main visual problems reported by the elderly were impaired vision 224 (44.8%) and abnormal sensations in the eyes 64 (12.8%). Cataract 198 (39.7%) was the commonest eye disorder diagnosed by the Family Physician, followed by pterygium 32 (6.4%). Assessment of binocular acuity revealed blindness in 109 (21.8%) and low-vision in 68 (13.6%). The prevalence of visual impairment increased significantly with age. CONCLUSION: Visual impairment is a common problem of the elderly people in the hospital setting, with cataract being the main cause. Efforts should be made to detect these conditions early and institute treatment promptly.

ASSESSMENT OF SOCIOECONOMIC STATUS AND CONTROL OF ASTHMA IN ADULTS.

BACKGROUND: Asthma is a chronic disease which places considerable economic, social and public health burdens on the society. Education, occupation and income are the most widely used indicators of socioeconomic status (SES). Studies have shown increased asthma hospital admissions for those who are materially deprived and increased asthma severity in low social class groups. The aim of this study is to determine the impact of socioeconomic status on control of asthma in adults. METHOD: The study was a cross-sectional analytical one, conducted over a year at the Medical Outpatient Clinic of the University College Hospital Ibadan. The study population was composed of 355 randomly selected adults aged between 18years and 55years with an established diagnosis of asthma already on treatment. RESULTS: Respondents with monthly income of 40000 and above had a higher proportion with good asthma control (74.1%) compared to those that earned 10000 to 39999 (69.0%) and less than 10000 (47.8%). This was statistically significant. Respondents in occupational class I/II had a slightly higher proportion with good asthma control (70.9%) compared to those in occupation class III/IV (70.1%) and occupation class V/VI (50.6%). This was statistically significant at p = 0.003. CONCLUSION: Respondents in the higher occupational class had better asthma control than respondents in the lower occupational class. Respondents who were earning 40000 and above as monthly income had better control of asthma than other respondents. After adjusting for other variables, the predictor of good asthma control was monthly income of the respondents.

Demographic factors in HIV infected patients seen at UCH, Ibadan, Nigeria.

There is a rising rate of Human Immunodeficiency Virus (HIV) infection in Nigeria. Good knowledge of the demographic characteristics of the patients with HIV/AIDS may be of great importance in understanding its epidemiology in Nigeria and could facilitate efforts at curtailing the spread of the infection. The study was planned to determine the demographic factors in Nigerian patients with HIV infection. The study was conducted at the University College Hospital (U.C.H), Ibadan, located in the South West of Nigeria. It was a retrospective study of patients with HIV infection attending the U.C.H. from 1988 to 2002. The data collected from the clinical records of the patients with HIV infection included age, sex, marital status, number of spouses, tribe, occupation, education and their religious affiliation. A total of 460 patients aged 1-76 years with peak at 30-34 years were studied. The male/female ratio was 1.06 and the males were the older group. Traders accounted for 40% with female preponderance while the artisans (19.9%) and the military (2.9%) were mostly males. The patients were of Yoruba (70.6%), Igbo (20.0%) and Hausa (9.1%) races. Among the patients with marital status, majority (71.4%) were married while those separated and widowed accounted for 3.5% and 2.6% respectively. Also, a higher proportion of the female HIV patients were Christians whereas the majority of the males were of Islamic religion. Although, there was a low frequency of records on education, the males had better formal education. In conclusion, the study shows that HIV infection is presently an adult disease affecting the most productive segment of the Nigerian population regardless of the individual occupation, educational status, tribe and religious affiliation. Also, it shows that the infection could be associated with heterosexual intercourse.

Frequency and Pattern of Lower Urinary Tract Symptoms in a screened population of Men above 40 Years in Ibadan, Southwestern Nigeria.

BACKGROUND: The epidemiology of lower urinary tract symptoms in adult men in Nigeria is presently not well known. AIM: To evaluate a screened population of men for lower urinary tract symptoms and their impact on the participants' quality of life. METHODS: A cohort study was conducted among men aged 40 years and older from 3 selected centres in Ibadan, Southwestern Nigeria. The presence of lower urinary tract symptoms and their impact was determined using the International Prostate Symptom Score (IPSS) administered via standardized questionnaires. RESULTS: Six hundred and fifty-five men participated in the study. The median age was 56 years with a range of 40 - 92 years. Eight percent (8%) of respondents were asymptomatic, whilst 66%, 20% and 6% had mild, moderate and severe symptoms respectively. Nocturia was the most common symptom and the second most troublesome. Overall storage (irritative) symptoms occurred with the similar frequency to voiding (obstructive) symptoms (91% v 92%), but voiding symptoms were more likely to be severe and thus more troublesome (p = <0.000.1). The severity of the individual symptoms as well as the overall score also increased significantly with age [p = 0.001]. There was a high correlation between IPSS and Quality of Life (QoL) scores (correlation coefficient 'r' = 0.75 [p = <0.0001]. Despite this, 72% of QoL respondents were satisfied with their quality of life. CONCLUSION: The frequency of non-troublesome lower urinary tract symptoms was high in adult men in this cohort of men in Southwestern Nigeria and that severity was age-related. In addition, whilst storage and voiding symptoms occurred with similar frequency, voiding symptoms were the more severe and troublesome.

Angiotensinogen gene in human hypertension. Lack of an association of the 235T allele among African Americans.

The frequency of the 235T and 174M alleles of the angiotensinogen gene, previously reported to be associated with hypertension in Caucasians and Japanese, was compared between 57 hypertensive African Americans and 130 normotensive African Americans sampled as part of a community survey of hypertension in the Chicago area. The frequency of the 235T allele was unrelated to hypertension status (cases, 83%, control subjects, 82%), as was true for the 174M allele. Compared with Caucasians, the frequency of the 235T allele was twice as high in this African American population, while the frequency of the 174M allele was similar. Even higher frequencies of the 235T allele (93%) were noted in a sample of 122 Nigerians. It appears that the 235T allele is very common in populations of West African origin, although we found no evidence that it confers risk of hypertension.

Maximum-likelihood generalized heritability estimate for blood pressure in Nigerian families.

Elevated blood pressure (BP) is more common in relatives of hypertensives than in relatives of normotensives, indicating familial resemblance of the BP phenotypes. Most published studies have been conducted in westernized societies. To assess the ability to generalize these estimates, we examined familial patterns of BP in a population-based sample of 510 nuclear families, including 1552 individuals (320 fathers, 370 mothers, 475 sons, and 387 daughters) from Ibadan, Nigeria. The prevalence of obesity in this community is low (body mass index: fathers, 21.6; mothers, 23.6; sons, 19.2; and daughters=21.0 kg/m2). The BP phenotype used in all analyses was created from the best regression model by standardizing the age-adjusted systolic blood pressure (SBP) and diastolic blood pressure (DBP) to 0 mean and unit variance. Heritability was estimated by use of the computer program SEGPATH from the most parsimonious model of "no spouse and neither gender nor generation difference" as 45% for SBP and 43% for DBP. The lack of a significant spouse correlation is consistent with little or no influence of the common familial environment. However, the heritability estimate of <50% for both SBP and DBPs reinforces the importance of the nonshared environmental effect.

Rift Valley fever in Nigeria: infections in humans.

Between 1985 and 1989, a total of 3,121 human sera collected from different population groups in six ecological zones of Nigeria were tested for the presence of antibodies to Rift Valley fever (RVF) virus by the haemagglutination-inhibition test. All reactive sera were further tested by the plaque reduction neutralisation test and specific RVF immunoglobulin M (IgM) assay. A total of 461 sera (14.8%) demonstrated haemagglutination-inhibiting antibody and 390 of the 461 initially reactive sera (84.6%) revealed neutralising antibodies. A significantly higher exposure to the virus was found among livestock workers and wildlife rangers than in other categories of people tested. The rate of positive reactions was higher in adults of 30 years or more than in younger age groups. Of 461 sera tested for specific RVF IgM, 107 gave positive results (23.2%). The highest prevalence of RVF IgM was found among livestock and forestry workers. In the longitudinal survey, an RVF virus infection rate of 6.7% was demonstrated. The infection rate was significantly higher during the wet season than during the dry season of the same year.

SYMPTOMATOLOGY AND COMORBIDITY OF SOMATIZATION DISORDER AMONGST GENERAL OUTPATIENTS ATTENDING A FAMILY MEDICINE CLINIC IN SOUTH WEST NIGERIA.

BACKGROUND: Individuals with somatization may be the most difficult to manage because of the diverse and frequent complaints across many organ systems. They often use impressionistic language to describe circumstantial symptoms which though bizarre, may resemble genuine diseases. The disorder is best understood in the context "illness" behaviour, masking underlying mental disorder, manifesting solely as somatic symptoms or with comorbidity. OBJECTIVE: To evaluate somatization symptoms and explore its comorbidity in order to improve the management of these patients. METHODS: A cross-sectional survey of 60 somatizing patients who were part of a case-control study, selected by consecutive sampling of 2668 patients who presented at the Family Medicine Clinic of University College Hospital Ibadan, Nigeria between May-August 2009. Data was collected using the ICPC-2, WHO- Screener and Diagnostic Schedule and analysed with SPSS 16. RESULTS: There were at least 5 symptoms of somatization in 93.3% of the patients who were mostly females. Majority had crawling sensation, "headache", unexplained limb ache, pounding heart, lump in the throat and insomnia. The mean age at onset was 35yrs with 90% having recurrence of at least 10yrs.Approximately 54% had comorbidity with cardiovascular disease being the most prevalent. CONCLUSIONS: The study revealed that somatization is not a specific disease but one with a spectrum of expression. This supports proposition that features for the diagnosis of somatization could be presence of three or more vague symptoms and a chronic course lasting over two years. It is important to be conversant with pattern of symptoms and possible comorbidity for effective management of these patients.

Knowledge and Perception of Nigerian Men 40 years and above Regarding Prostate Cancer.

BACKGROUND: Carcinoma of the prostate is now the most commonly diagnosed male cancer worldwide. However, knowledge and perception of Nigerian men about the disease has not been fully investigated. AIM: To determine the level of awareness about prostate cancer among men 40 years and older in Ibadan, Southwestern Nigeria. METHOD: Four focus group discussions were used to obtain information from 29 randomly- selected Nigerian men, aged 40 years and above, about their knowledge of the common causes of morbidity and mortality among men of their age group as well as prostatic diseases and their perceived causes. In-depth interviews were then conducted among 656 participants using questionnaires. RESULTS: Generally, the respondents and discussants were unaware of the prostate gland and its diseases; whilst relatively few knew about carcinoma of the prostate and most were ignorant of the symptoms of the disease. Among discussants and respondents who knew about the gland, most thought that benign and malignant prostatic diseases were long-term complications of promiscuity and sexually transmitted infections. All the participants were interested in receiving information about all aspects of carcinoma of the prostate. CONCLUSION: . These results indicate that a large proportion of adult Nigerian men are ignorant of the prostate gland and its diseases in general, and carcinoma of the prostate in particular. There is therefore the need for community awareness programs on prostatic diseases in our locality.

Hypertension, serum angiotensinogen, and molecular variants of the angiotensinogen gene among Nigerians.

BACKGROUND: We evaluated the association among the M235T and T174M variants of the angiotensinogen (AGT) gene, plasma AGT, and hypertension status in a sample of Nigerians. METHODS AND RESULTS: Participants were selected from the extremes of the blood pressure distribution obtained from the population survey of 2509 men and women aged 25 to 74 years. Cases (hypertensive subjects) were individuals who had high blood pressure or were taking antihypertensive medication, and control subjects were individuals with low blood pressure who had never taken antihypertensive medication. We found a significant association between the M235T variant and plasma AGT level. Hypertensive subjects had higher plasma AGT levels compared with control subjects. The allele frequencies of the two variants were similar in the hypertensive patients and the control subjects. CONCLUSIONS: The consistent relationships observed between the M235T variant and the protein product and between plasma level of the protein and hypertension status in different ethnic groups provide some evidence for a biochemical mechanism linking DNA variation in the renin-angiotensin system with the hypertension phenotype.

Serum distribution of lipoprotein(a) in African Americans and Nigerians: potential evidence for a genotype-environmental effect.

Differences in lipoprotein(a) [Lp(a)] levels across populations have been described and blacks are known to have higher Lp(a) values compared to whites. However, environmental factors which influence Lp(a) levels have been difficult to identify. We took advantage of the large environmental contrast which exists against a common genetic background between U.S. and Nigerian blacks to examine the relationship between Lp(a) and apolipoprotein(a) magnitude of apo(a) isoforms. Although the distribution of Lp(a) and apo(a) isoforms was nearly Gaussian in both populations, mean serum Lp(a) values were significantly higher in the United States than in Nigeria (20.5 vs. 12.7 mg/dl; P = 0.0001) and U.S. blacks had a higher frequency of the large molecular weight isoforms compared to Nigerians. Similar trends in the relationship between apo(a) isoform and Lp(a) concentration were seen in both populations; however, the magnitude of the effect was different. Compared to the Nigerians, U.S. blacks had significantly higher mean Lp(a) values for the same apo(a) isoform. The association of Lp(a) with low density lipoprotein-cholesterol (LDL-C) level was not significant after correcting for the contribution of Lp(a) cholesterol to LDL-C in both populations. Surprisingly, the association between Lp(a) and total-C remained significant (r = 0.20, P = 0.04) after similar correction for the contribution of Lp(a) cholesterol in the U.S. sample. Understanding the relationship between other factors including lifestyle characteristics capable of influencing total-C may help explain the unusually high Lp(a) level observed in this U.S. population.

Perceived family support and blood glucose control in type 2 diabetes

This study aimed to find out if levels of family support are correlated with blood glucose control among Nigerians with type 2 diabetes. One hundred and fifty (150) patients attending the diabetes clinic of the University College Hospital, Ibadan, were assessed for their perception of family support using a validated family support measure. Fasting plasma glucose was used as the index of glycaemic control, and 39% of subjects were rated as having 'strong' perceived family support, while 31% and 11% were rated wth 'weak' and 'no' perceived family support, respectively. Mean fasting plasma glucose was 7.0±2.5 mmol/L, with lower levels of blood glucose in those who perceived their family as supportive, compared with those who perceived their family as unsupportive. Positive family support was found to correlate positively with blood glucose control