Knowledge and Practice of the Referral System under the National Health Insurance Scheme among Medical and Dental Practitioners of A Large-Accredited Facility in Kano, Nigeria.

BACKGROUND: Studies on healthcare professionals' knowledge about the National Health Insurance Scheme (NHIS) are scarce. Therefore, we assessed the knowledge and practice of the NHIS referral system among Medical and Dental practitioners in a tertiary hospital in Northwest Nigeria. METHODS: This cross-sectional study involved 242 medical and dental practitioners randomly selected from nine departments for over 6-weeks. A structured self-administered questionnaire was used to collect data. Data were analyzed using descriptive and inferential statistics. RESULTS: The respondents' mean age was 35.7±6.0 years; they were predominantly males (64.9%). Their mean overall knowledge score was 58.9±23.0%, with 66.9% of respondents having inadequate overall knowledge of the NHIS referral system. Practice department (Fishers 2 exact, P=0.0019), perceived knowledge of the referral system (ꭓ =8.169, P=0.004), and having been referred as an enrolee (ꭓ2 = 6.358, P=0.012) were associated with overall-knowledge. Obstetrics-and-Gynaecology (odds ratio[OR]=0.29, 95% confident interval [CI] [0.88-0.98]), Dental and-Maxillofacial-Surgery (OR=0.08, 95%CI[0.01-0.98]), and Otorhinolaryngology (OR=0.18, 95%CI[0.04-0.80]) respondents were less likely to have adequate overall-knowledge.Although 56.2%, 50.4%, 20.7%, and 89.7% were enrolees, had received treatment as enrolees, had been referred as enrolees and treated other enrolees, respectively, an unimpressive proportion had sighted a referral letter (64.9%) or authorization code on the letter (25.2%), referred an enrolee from their department previously (51.2%) or used the NHIS referral form to write referrals (38.8%). CONCLUSION: The overall knowledge of the NHIS referral system was inadequate. The practice of the referral system was below expectation. Therefore, training medical and dental practitioners on the NHIS referral system is necessary. Training should target those who are least likely to have adequate overall knowledge.

CONTEXTE: Les études sur les connaissances des professionnels de la santé concernant le Régime d'assurance maladie national (NHIS) sont rares. Nous avons donc évalué les connaissances et la pratique du système de référence du NHIS parmi les médecins et dentistes d'un hôpital tertiaire du Nord-Ouest du Nigeria. MÉTHODES: Cette étude transversale a impliqué 242 médecins et dentistes sélectionnés de manière aléatoire dans neuf départements pendant plus de 6 semaines. Un questionnaire structuré auto-administré a été utilisé pour recueillir des données. Les données ont été analysées à l'aide de statistiques descriptives et inférentielles. RÉSULTATS: L'âge moyen des répondants était de 35,7 ± 6,0 ans ; ils étaient principalement des hommes (64,9 %). Leur score moyen global de connaissances était de 58,9 ± 23,0 %, avec 66,9 % des répondants ayant une connaissance globale insuffisante du système de référence du NHIS. Le département de pratique (test exact de Fisher, P=0,0019), la connaissance perçue du système de référence (ꭓ 2 =8,169, P=0,004) et avoir été référé en tant qu'adhérent (ꭓ 2 = 6,358, P=0,012) étaient associés à la connaissance globale. Les répondants en obstétrique-gynécologie (rapport des cotes [OR]=0,29, intervalle de confiance à 95 % [IC] [0,88-0,98]), en chirurgie dentaire et maxillo-faciale (OR=0,08, IC à 95 % [0,01-0,98]), et en oto-rhino-laryngologie (OR=0,18, IC à 95 % [0,04-0,80]) étaient moins susceptibles d'avoir une connaissance globale adéquate. Bien que 56,2 %, 50,4 %, 20,7 % et 89,7 % étaient adhérents, avaient reçu un traitement en tant qu'adhérents, avaient été référés en tant qu'adhérents et avaient traité d'autres adhérents, respectivement, une proportion peu impressionnante avait vu une lettre de référence (64,9 %) ou un code d'autorisation sur la lettre (25,2 %), avait référé un adhérent de leur département précédemment (51,2 %) ou avait utilisé le formulaire de référence du NHIS pour écrire des références (38,8 %). CONCLUSION: La connaissance globale du système de référence du NHIS était insuffisante. La pratique du système de référence était en deçà des attentes. Par conséquent, la formation des médecins et dentistes sur le système de référence du NHIS est nécessaire. La formation devrait cibler ceux qui sont moins susceptibles d'avoir une connaissance globale adéquate. MOTS-CLÉS: Connaissances et Pratiques, Professionnels de la santé, Régime national d'assurance maladie, Nigeria, Renvoi.

COVID-19 Pandemic Response: A Primary Care Experience in Northwest Nigeria.

The effectiveness of healthcare systems during this COVID-19 pandemic will largely depend on their resilience in the face of untold challenges. Hence, we share the ongoing experience of the response of a primary care facility to challenges of the increasing number of undifferentiated patient load in the context of rising COVID-19 cases, infrastructural gap, limited personal protective equipment, and the health workforce in a densely populated town.

L'efficacité des systèmes de soins de santé au cours de la pandémie de COVID-19 dépendra en grande partie de leur résistance face à des défis incalculables. Nous partageons donc l'expérience en cours de la réponse d'un établissement de soins primaires aux défis posés par le nombre croissant de patients indifférenciés dans le contexte de l'augmentation des cas de COVID-19, des lacunes infrastructurelles, de l'équipement de protection individuelle limité et du personnel de santé dans une ville densément peuplée. Mots-clés : COVID-19, Résilience du système de santé, Patients ambulatoires, Pandémie, Soins primaires.

Socio-economic and Lifestyle Determinants of Functional Capacity of the Senior Attendees of an Outpatient Clinic in Northern Nigeria: A Cross-Sectional Study.

BACKGROUND: Typical ageing changes and the associated health concerns frequently manifest themselves as reduction in their efficiency and functional capacity. OBJECTIVE: To identify the socioeconomic and lifestyle determinants of the functional capacity of elderly patients. METHODS: A cross-sectional study involving 329 patients aged ≥ 60 years who presented to the General Outpatient Clinic. Data on socioeconomic, lifestyle, and functional capacity were collected. The functional capacity was assessed by the self-reported questionnaires: the Lawton and Katz indexes for the activity of daily living (ADL) and instrumental activity of daily living (IADL) respectively. The chi-square test and logistic regression analysis were used to determine associations between the variables. The level of significance was set at a p-value ≤ 0.05. RESULTS: A total of 312 respondents completed the study, with 59.6% females and a mean age of 67.67 ± 7.69 years. The majority of the respondents (76.3%) belong to the low socioeconomic status (classes V and VI). The prevalence of functional dependence was 21.5% and 44.2% for ADL and IADL respectively. The disability in continence and food preparation had the highest prevalence among the components of ADL and IADL respectively. Advancing age, Hausa/Fulani tribe, polygamy, poor social support, and chronic pain were the determinants of functional dependence in ADL while age, female gender, marital status, and Fulani tribe were the determinants of functional dependence in IADL among the respondents.CONCLUSION: The identified determinants of functional capacity among the older persons should be considered when assessing their functional capacity in the primary care or similar settings.

CONTEXTE: Les changements typiques liés au vieillissement et les problèmes de santé qui y sont associés se manifestent souvent par une réduction de l'efficacité et de la capacité fonctionnelle. OBJECTIFS: Identifier les déterminants socio-économiques et le mode de vie de la capacité fonctionnelle des patients âgés. MÉTHODES: Étude transversale portant sur 329 patients âgés de ≥ 60 ans qui se sont présentés à la consultation externe générale. Des données sur la situation socio-économique, le mode de vie et la capacité fonctionnelle ont été recueillies. La capacité fonctionnelle a été évaluée à l'aide de questionnaires autodéclarés : les indices de Lawton et de Katz pour l'activité de la vie quotidienne (ADL) et l'activité instrumentale de la vie quotidienne (IADL) respectivement. Le test du chi carré et l'analyse de régression logistique ont été utilisés pour déterminer les associations entre les variables. Le niveau de signification a été fixé à une valeur p ≤ 0,05. RÉSULTATS: Au total, 312 personnes ont répondu à l'étude, dont 59,6 % de femmes et un âge moyen de 67,67 ±7,69 ans. La majorité des personnes interrogées (76,3 %) appartiennent à un statut socioéconomique faible (classes V et VI). La prévalence de la dépendance fonctionnelle était de 21,5 % et 44,2 % pour les AVQ et les AIVQ respectivement. Les incapacités liées à la continence et à la préparation des repas ont la prévalence la plus élevée parmi les composantes des AVQ et des AIVQ respectivement. L'âge avancé, la tribu Hausa/Fulani, la polygamie, le manque de soutien social et la douleur chronique étaient les déterminants de la dépendance fonctionnelle dans les AVQ, tandis que l'âge, le sexe féminin, l'état matrimonial et la tribu Fulani étaient les déterminants de la dépendance fonctionnelle dans les AIVQ parmi les personnes interrogées. CONCLUSION: Les déterminants identifiés de la capacité fonctionnelle chez les personnes âgées devraient être pris en compte lors de l'évaluation de leur capacité fonctionnelle dans le cadre des soins primaires ou dans des contextes similaires. Mots clés: Capacité fonctionnelle, Socio-économie, Mode de vie, Personnes âgées et nord du Nigeria.

DIETARY LIFESTYLE, HYPOALBUMINAEMIA AND ANAEMIA AMONG OLDER ADULTS ATTENDING A PRIMARY CARE CLINIC IN NIGERIA: A CROSS-SECTIONAL STUDY.

Introduction: Anaemia has been extensively studied in children and women of reproductive age. However, there are few data on anaemia and related conditions in the elderly from developing countries. Objectives: To determine the prevalence and severity pattern of anaemia, and assess the relationship between dietary lifestyle, hypoalbuminaemia, and anaemia in older persons. Methodology: A cross-sectional study involving 378 patients aged≥60 years who presented at the General Outpatient Clinic. Dietary lifestyle was assessed using a structured questionnaire. Samples were collected for packed cell volume and serum albumin. Inferential statistical analyses were used to determine the associations between variables. Results: A total of 348 respondents completed the study. The mean age of respondents was 67.83 ±7.53 years with female (60.9%) predominance. The prevalence of anaemia and hypoalbuminaemia were 42.2% and 17.8% respectively. Hypoalbuminaemia (ß=0.335, 95%CI=0.131-0.229, P<0.001), long duration of co-morbidities (ß= - 0.179, 95%CI= -0.165-0.047, P<0.001), one full meal/day (ß=0.130, 95%CI=0.224-1.879, P=0.013), and low monthly income (ß=0.122, 95%CI=0.179-1.543, P=0.026) were the predictors of anaemia among the elderly in this study. Conclusion: Data on the predictors of anaemia from this study will be useful in developing guidelines and strategies for managing the condition in primary care settings and other similar sites.

Correlates of Depression among Elderly Patients Attending the General Out-Patient Department of a Tertiary Hospital in Northwestern Nigeria.

BACKGROUND: Depression is a common mental health problem in the geriatric population associated with significant morbidity (including decreased physical, cognitive and social functioning) and mortality. Although patients differ in their presentations, certain social and demographic characteristics are common to the elderly population with depression. It is hoped that identifying these patients based on their sociodemographic characteristics will help reduce the difficulties in diagnosis. OBJECTIVE: The objective of this study is to determine the risk factors for depressive illness among elderly patients attending the GOPD of AKTH. METHODS: This cross-sectional questionnaire-based study involved 392 elderly patients systematically selected from Family Medicine Clinic attendees in Kano, Nigeria. Data collected included sociodemographic and clinical characteristics. Geriatric Depression Scale was used to screen for depression. Chi-square test and logistic regression analysis were used to determine the association between categorical variables and predictors of depression among participants, respectively. RESULTS: The prevalence of depression prevalence was 22.4%. Most participants were females aged 60-69 years (62.5%), Hausas (77.6%) and living with their spouses and children (77.3%). Gender, marital status, marital setting, socio-economic class, osteoarthritis and body-mass index were associated with depression. The predictors of depression were female gender (p=0.014, OR=1.401, CI=1.757- 2.591), widows/widowers (p=0.030, OR=4.533, CI= 1.186-17.317) and obesity (p=0.001, OR=5.644, CI=2.759-11.544). CONCLUSION: The high prevalence of depression among this population highlights the need for screening. Females, widows/ widowers and obese geriatric patients are more likely to be depressed and should be targeted for screening in our busy outpatient setting.

CONTEXTE: La dépression est un problème de santé mentale courant dans la population gériatrique associée à une morbidité significative(y compris une diminution du fonctionnement physique, cognitif et social) et mortalité. Bien que les patients diffèrent dans leurs présentations, certains et les caractéristiques démographiques sont communes à la population âgée avec dépression. On espère que l'identification de ces patients sur la base deleurs caractéristiques sociodémographiques aideront à réduire les difficultés dans le diagnostic. OBJECTIF: L'objectif de cette étude est de déterminer le risque facteurs de la maladie dépressive chez les patients âgés fréquentant leGOPD de AKTH. MÉTHODES: Cette étude transversale basée sur un questionnaire a impliqué 392 patients âgés systématiquement sélectionnés dans famille participants à la clinique de médecine à Kano, au Nigeria. Les données recueillies comprenaient :caractéristiques sociodémographiques et cliniques. Dépression gériatrique l'échelle a été utilisée pour dépister la dépression. Test et logistique du chi carréune analyse de régression a été utilisée pour déterminer l'association entre variables catégorielles et prédicteurs de la dépression chez les participants respectivement. RÉSULTATS: La prévalence de la prévalence de la dépression était de 22,4 %.La plupart des participants étaient des femmes âgées de 60 à 69 ans (62,5 %), des Haoussas(77,6 %) et vivant avec leur conjoint et leurs enfants (77,3 %). Genre, le status matrimonial, milieu conjugal, classe socio-économique, arthroseet l'indice de masse corporelle étaient associés à la dépression. Les prédicteurs de la dépression étaient de sexe féminin (p = 0,014, RC = 1,401, IC = 1,757-2,591), veuves/ veufs (p=0,030, OR=4,533, IC= 1,186-17,317)et l'obésité (p = 0,001, RC = 5,644, IC = 2,759-11,544). CONCLUSION: La forte prévalence de la dépression parmi cette population souligne la nécessité d'un dépistage. Femmes, veuves/les veufs et les patients gériatriques obèses sont plus susceptibles d'être dépriméset devrait être ciblé pour le dépistage dans notre milieu ambulatoire occupé. Mots-clés MeSH: 'Vieillissement' 'personnes âgées' 'dépression' 'obésité' 'genre.

Informed Consent: The Surgical Patient's Experience in a Tertiary Hospital in Northwest Nigeria.

BACKGROUND: Obtaining informed consent (IC) before a surgical procedure is the cornerstone of medical practice. The practice of IC continues to evolve as litigations increase. Most studies on patients' perspectives of IC are either old or were done in southern Nigeria. This study assessed the surgical patients' IC experience in a tertiary hospital in northwest Nigeria. METHODS: This cross-sectional study assessed 244 consecutive patients who had elective surgeries in surgical departments of a tertiary hospital. Pretested questionnaires were used to collect data regarding their perception of the meaning of IC, the process of obtaining it, satisfaction with how it was obtained, and factors associated with satisfaction on how consent was obtained. RESULTS: Most were females (61.9%); their mean age was 34.8±14.3 years; 52.9% and 61.9% of respondents did not believe that IC enables patient-clinician shared decision-making or patient's self-decision making, respectively. Most were allowed to ask questions (83.2%), received information on the surgical procedure (91.4%), diagnosis (97.9%); however, 38.5% and 48.8% did not receive information about surgical procedures' immediate and long-term complications, respectively. Surgical procedure explanation was mostly provided by Resident Doctors (53.7%). Most (88.9%) were satisfied with how IC was obtained; satisfaction was associated with being allowed to ask questions, receiving explanations on diagnosis, surgical-procedure, complications of surgery, available alternative treatments, and when the resident/ consultants gave the explanation (all P<0.05). CONCLUSION: Deficiencies exist in the process of getting IC. Satisfaction with this process was high though associated with following the recommended strategies. Improving the IC process will require appropriate interventions in this and similar settings.

CONTEXTE: Obtention du consentement éclairé (CI) avant une intervention chirurgicale la procédure est la pierre angulaire de la pratique médicale. La pratique de l'IC continue d'évoluer à mesure que les litiges augmentent. La plupart des études sur les patients les perspectives d'IC sont soit anciennes, soit ont été faites dans le sud du Nigeria.Cette étude a évalué l'expérience IC des patients chirurgicaux dans un tertiaire hôpital dans le nord-ouest du Nigeria. MÉTHODES: Cette étude transversale a évalué 244 études consécutives les patients qui ont subi des chirurgies non urgentes dans les services chirurgicaux d'un tertiaire hôpital. Des questionnaires prétestés ont été utilisés pour recueillir des données concernant leur perception de la signification de l'IC, le processus d'obtention,la satisfaction à l'égard de la façon dont il a été obtenu et les facteurs associés à la satisfaction quant à la façon dont le consentement a été obtenu. RÉSULTATS: La plupart étaient des femmes (61,9 %); leur âge moyen était de 34,8 ±14,3 ansannées; 52,9 % et 61,9 % des répondants ne croyaient pas que l'IC permettait la prise de décision partagée patientclinicien ou l'auto-décision du patientfaire, respectivement. La plupart ont été autorisés à poser des questions (83,2 %),reçu de l'information sur l'intervention chirurgicale (91,4 %), le diagnostic(97,9%); toutefois, 38,5 % et 48,8 % n'ont pas reçu d'information sur les complications immédiates et à long terme des interventions chirurgicales, respectivement. L'explication de la procédure chirurgicale a été principalement fournie par médecins résidents (53,7 %). La plupart (88,9 %) étaient satisfaits de la façon dont IC a été obtenu; la satisfaction était associée au fait d'être autorisé àposer des questions, recevoir des explications sur le diagnostic, la procédure chirurgicale,complications de la chirurgie, traitements alternatifs disponibles et quandle résident/les consultants ont donné l'explication (tous P<0.05). CONCLUSION: Des lacunes existent dans le processus d'obtention de l'IC.La satisfaction à l'égard de ce processus était élevée, bien qu'elle soit associée à en suivant les stratégies recommandées. L'amélioration du processus de CI permettra nécessitent des interventions appropriées dans ce contexte et dans des contextes similaires. Mots-clés: Consentement éclairé, Kano, expérience du patient, chirurgiepatients, hôpital tertiaire.

Predictors of Satisfaction with Wound Care Services in an Outpatient Setting in Kano, Nigeria.

BACKGROUND: With the global increase in chronic wounds and the paucity of studies on patient experiences at wound care facilities, we assessed the factors associated with satisfaction with wound care services among patients or their caregivers in a Northwest Nigerian outpatient setting. METHODS: Participants were systematically selected from patients or their caregivers attending the General Outpatient Clinic of Aminu Kano Teaching Hospital, Kano, for wound dressing. A structured self-administered questionnaire was used to obtain information regarding their sociodemographic and clinical characteristics and satisfaction with service domains. Data were analyzed using descriptive and inferential statistical methods. RESULTS: There were 170 participants. Their mean age was 31.9±11.4 years, and they were mainly female (55.3%). The overall satisfaction rate was 85.9% (146/170); however, 51.8% and 55.3% of participants were dissatisfied with the advice on home wound care and waiting time, respectively. Employment status, wound location, having sickle cell disease, needing a wheelchair to reach the wound dressing room and perceived availability of a wheelchair were associated with overall satisfaction (P<0.05). The predictors of overall satisfaction were chronic wounds, wound in areas other than the lower limbs/buttocks, and perceived availability of wheelchairs. CONCLUSION: The overall satisfaction rate was high despite service gaps. However, future improvement in patient satisfaction will require addressing challenges such as the waiting time before wound dressing, equipment (e.g., wheelchairs), and staffing.

CONTEXTE: Avec l'augmentation mondiale du nombre de plaies chroniques et le manque d'études sur les expériences des patients aux centres de soin des plaies, nous avons évalué les facteurs associés à la satisfaction des services de soins des plaies chez les patients ou leurs soignants dans une établissement de soins ambulatoires du nord-ouest du Nigeria. MÉTHODES: Les participants ont été systématiquement sélectionnés parmi les patients ou leurs soignants fréquentant la clinique externe générale de l'hôpital universitaire d'Aminu Kano à kano, pour le traitement des plaies. Un questionnaire structuré auto-administré a été utilisé pour obtenir des informations sur les caractéristiques sociodémographiques et cliniciques et leur satisfaction à l'égard des services. Les données ont été analysées à l'aide de méthodes statistiques descriptives et inférentielles. RÉSULTATS: Il y avait 170 participants. Leur âge moyen était de 31,9±11,4 ans, et ils étaient principalement des femmes (55,3 %). Le taux de satisfaction global était de 85,9 % (146/170) ; cependant, 51,8 % et 55,3 % des participants étaient insatisfaits des conseils sur le traitement des plaies à domicile et du temps d'attente, respectivement. Le statut professionnel, l'emplacement de la plaie, le fait d'avoir une drépanocytose, besoin d'un fauteuil roulant pour atteindre la salle de pansements et la disponibilité perçue d'un fauteuil roulant étaient associés à la satisfaction globale (P<0,05). Les facteurs prédictifs de la satisfaction globale étaient les plaies chroniques, les plaies situées dans des zones autres que les membres inférieurs/fesses et la disponibilité perçue des fauteuils roulants. CONCLUSION: Le taux de satisfaction globale était élevé malgré les lacunes des services. Cependant, l'amélioration future de la satisfaction des patients nécessitera relever des défis tels que le temps d'attente avant le pansement des plaies, l'équipement (p. ex., les fauteuils roulants) et la dotation en personnel. MOTS-CLÉS: Patients externes, Caractéristiques des patients, Satisfaction des patients, Soins des plaies, Pansements.

Multimorbidity and Functional Status of the Elderly in a Primary Care Setting of Northern Nigeria: A Cross-Sectional Study.

BACKGROUND: Globally, multimorbidity has attracted considerable attention in recent years. In resource-poor settings, the elderly bears the highest burden of chronic illnesses. Poor outcomes associated with multimorbidity in the elderly are well reported. However, the relationship between multimorbidity and functional status in elderly patients in developing countries is poorly understood. OBJECTIVE: To examine the burden of multimorbidity and functional disability as well as the factors associated with multimorbidity among the elderly in a primary care setting in Kano. METHODS: This was a cross-sectional study of 279 elderly patients randomly selected among the General Outpatient Clinic attendees of a Nigerian tertiary hospital. Data on participants' socio-demographics and diagnoses were collected. The Katz activity of daily living index was used to assess functional status. Data were analysed using SPSS and odds ratios were calculated. RESULTS: Participants were predominantly females (66.7%). The prevalence of multimorbidity and functional disability were 72.0% and 16.9%, respectively. Functional disability was found to have a positive interplay with multimorbidity (OR=20.819, 95%CI=1.752-247.4 and p=0.016). Other predictors of multimorbidity were lack of formal education (OR=0.362, 95%CI=0.141-0.931, p=0.035), unemployment (OR=0.386, 95%CI=0.165-0.903, p=0.028), and increased Body Mass Index (OR=218.8, 95%CI=12.090-3961.8 p<0.001). CONCLUSION: The burden of multimorbidity and functional disability is high. The predictors in this study could be valuable in identifying the elderly with greater risk of becoming multimorbid in similar primary care settings.

CONTEXTE: À l'échelle mondiale, la multimorbidité a suscité une attention considérable ces dernières années. Dans les milieux pauvres en ressources, les personnes âgées portent le fardeau le plus lourd des maladies chroniques. Les mauvais résultats associés à la multimorbidité chez les personnes âgées sont bien rapportés. Cependant, la relation entre la multimorbidité et l'état fonctionnel chez les patients âgés dans les pays en développement est mal comprise. OBJECTIF: Examiner le fardeau de la multimorbidité et de l'incapacité fonctionnelle ainsi que les facteurs associés à la multimorbidité chez les personnes âgées dans un établissement de soins primaires à Kano. MÉTHODES: Il s'agissait d'une étude transversale portant sur 279 patients âgés choisis au hasard parmi les participants à la clinique ambulatoire générale d'un hôpital tertiaire nigérian. Des données sur les caractéristiques sociodémographiques et les diagnostics des participants ont été recueillies. L'indice d'activité de la vie quotidienne de Katz a été utilisé pour évaluer l'état fonctionnel. Les données ont été analysées à l'aide de SPSS et les rapports de cotes ont été calculés. RÉSULTATS: Les participants étaient majoritairement des femmes (66,7 %). La prévalence de la multimorbidité et de l'incapacité fonctionnelle était respectivement de 72,0 % et 16,9 %. L'incapacité fonctionnelle s'est avérée avoir une interaction positive avec la multimorbidité (OR = 20,819, IC à 95 % = 1,752- 247,4 et p = 0,016). Les autres prédicteurs de la multimorbidité étaient le manque d'éducation formelle (OR=0,362, IC à 95 %=0,141-0,931, p=0,035), le chômage (OR=0,386, IC à 95 %=0,165-0,903, p=0,028) et l'augmentation de la masse corporelle Indice (OR=218,8, IC à 95 %=12,090-3961,8 et p<0,001). CONCLUSION: Le fardeau de la multimorbidité et du handicap fonctionnel est élevé. Les prédicteurs de cette étude pourraient être utiles pour identifier les personnes âgées présentant un risque accru de devenir multimorbide dans des établissements de soins primaires similaires.

Missed Elevated Blood Pressure in Triaged Outpatients: A Preliminary Cross-Sectional Multicentre Study in Northern Nigeria.

BACKGROUND: Hypertension is a common medical condition but largely undiagnosed, untreated, poorly controlled, and undertreated in low- and middle-income countries. Studies have reported missed hypertension during triage in Emergency Departments; however, little is known about missed elevated blood pressure (EBP) during triage in primary care settings. This study assessed the prevalence and predictors of missed EBP among triaged patients attending General Outpatient Clinics in Northern Nigeria. METHODS: This was a descriptive cross-sectional multi-centre study involving 187 adults randomly selected from patients triaged in four General Outpatient Clinics in northern Nigeria. An investigator-administered questionnaire was employed to obtain data regarding participants' socio-demographic, triage blood pressure (BP) measurement, physician-led BP measurement, and physicians' clinical decision characteristics. Chi-square test and logistic regression analysis were used to determine factors associated with and predictors of missed EBP, respectively. RESULTS: Participants' mean age was 40.6±14.7years. They were predominantly females (122, 65.2%). EBP was missed in 28 (15%) participants at the triage. Participants' age (>40years) (Odds ratio [OR]=3.82, 95% Confidence interval [CI]=1.43-10.22, P=0.008), study site (OR=0.32, 95% CI=0.12-0.82, P=0.018) and perceived receipt of explanation on BP measurement procedure (OR=2.97, 95% CI=1.25-7.07, P=0.014) were predictors of missed EBP among participants. CONCLUSION: The prevalence of missed EBP was low but remarkable because of its huge public health implications. Age, study site, perceived receipt of explanation on BP measurement procedure predicted missed EBP. Effective interventions are needed to curtail missed EBP in these and similar settings.

RÉSUMÉ: L'hypertension est une condition médicale courante mais en grande partie non diagnostiquée, non traitée, mal contrôlée et sous-traitée dans les pays à revenu faible et intermédiaire. Des études ont signalé une hypertension manquée lors du triage dans les services d'urgence; Cependant, on sait peu de choses sur l'hypertension artérielle (EBP) manquée lors du triage dans les établissements de soins primaires. Cette étude a évalué la prévalence et les prédicteurs de l'EBP manquée parmi les patients triés fréquentant les cliniques externes générales dans le nord du Nigeria. MÉTHODES: Il s'agissait d'une étude multicentrique transversale descriptive portant sur 187 adultes choisis au hasard parmi des patients triés dans quatre cliniques ambulatoires générales dans le nord du Nigéria. Un questionnaire administré par l'investigateur a été utilisé pour obtenir des données concernant les données sociodémographiques des participants, la mesure de la pression artérielle (PA) au triage, la mesure de la PA dirigée par un médecin et les caractéristiques de décision clinique des médecins. Un test du chi carré et une analyse de régression logistique ont été utilisés pour déterminer les facteurs associés et les prédicteurs de l'EBP manquée, respectivement. RÉSULTATS: L'âge moyen des participants était de 40,6 ± 14,7 ans. Il s'agissait majoritairement de femmes (122, 65,2 %). L'EBP a été manquée chez 28 (15 %) participants au triage. Âge des participants (> 40 ans) (rapport de cotes [OR] = 3,82, intervalle de confiance à 95 % [IC] = 1,43 à 10,22, P = 0,008), site d'étude (OR = 0,32, IC à 95 % = 0,12 à 0,82, P = 0,018) et la réception perçue d'explications sur la procédure de mesure de la PA (OR=2,97, IC à 95 %=1,25-7,07, P=0,014) étaient des prédicteurs d'EBP manquée chez les participants. CONCLUSION: La prévalence de l'EBP manquée était faible mais remarquable en raison de ses énormes implications pour la santé publique. L'âge, le site d'étude, la réception perçue d'explications sur la procédure de mesure de la PA prédisaient une EBP manquée. Des interventions efficaces sont nécessaires pour réduire l'EBP manquée dans ces contextes et similaires. MOTS CLÉS: tension artérielle élevée, hypertension, absence, consultations externes, soins primaires, triage.

Effect of Antenatal Couple Counselling on Postpartum Uptake of Contraception among Antenatal Clients and their Spouses attending Antenatal Clinic of a Northern Nigeria Tertiary Hospital: A Randomized Controlled Trial.

BACKGROUND: Contraceptive non-use has great influence on maternal health and mortality in Northern Nigeria. Contraception counselling improves utilization, compliance to and efficiency of contraceptive methods. This study aimed at determining the effect of antenatal couple counselling on postpartum uptake of contraception among antenatal clients and their spouses. MATERIALS AND METHODS: This was a randomized controlled trial of 150 antenatal clients with their spouses at a tertiary hospital in Northern Nigeria. Participants were randomly assigned to intervention and control groups. A well-designed questionnaire was used to assess participants' contraception awareness, contraceptive uptake pre- and post-intervention and husband participation. A validated counselling tool GATHER was used for the counselling. RESULTS: Baseline knowledge of contraception was high (92%) among participants however, contraceptive uptake was low (28.3%); there was no significant difference between intervention and control groups (P= 0.94) at baseline. Post-intervention, there was significant difference in postpartum contraceptive uptake between intervention and control groups (48.5% versus 31.0%, respectively; McNemar's chi-square P=0.0001). The determinants of postpartum contraceptive uptake were participants' educational status [Odds ratio (OR)= 10.26, 95% CI =1.31-80.48,P= 0.03], occupation (OR= 10.25, 95% CI=1.06-87.38,P=0.03) and husbands' participation (OR = 0.03, 95% CI = 0.005-0.21,P=0.0001). CONCLUSION: Antenatal couple counselling impacted positively on postpartum contraceptive uptake. Inclusion of antenatal couple contraception counselling services should be promoted.

Diagnosing Premalignant Lesions of Uterine Cervix in A ResourceConstraint Setting: A Narrative Review.

Cervical cancer is an important public health problem whose prevention should be integrated in all existing primary health care and women's health programmes in Nigeria and other developing countries. Cervical cancer is the second most common female malignancy in the world and it is the leading cause of cancer related deaths among women in developing countries. Furthermore, developing countries account for 80% of global deaths from cervical cancer. Early cancer detection remains a vital strategy for disease treatment and prevention; therefore the need for routine cervical screening cannot be overemphasized. Given the scope of the cervical dysplasia problem in our country, coupled with the difficulties that have been encountered in many of our health centres when attempting to implement cytology-based screening and colposcopy/biopsy programmes which remains the gold standard, there is the need to find an alternative, low-resource screening option. In most developing countries, patients often present late with advanced cancer of the cervix. Given the difficulty of ensuring high quality cytology-based services in many settings coupled with the absence of colposcopy, visual inspection of cervix with acetic acid (VIA) is a promising option in the new approach to screening for precancerous lesion, especially for low-resource settings. The front line doctor (family physician) and other para-medical staff, including nurses and midwives, require easily implemented procedures and protocols to be able to identify early cervical dysplasia and allow measures to be undertaken to prevent progression to carcinoma.

Delirium is a Strong Predictor of Mortality in Patients Receiving Non-invasive Positive Pressure Ventilation.

PURPOSE: Non-invasive positive pressure ventilation (NIPPV) has gained popularity over the years in the treatment of acute respiratory failure (ARF). Preliminary evidence suggests that delirium is an important factor contributing to NIPPV failure and death. This study was conducted to evaluate delirium and other associated factors of deaths in patients with ARF requiring the use of NIPPV. METHODS: A prospective observational study was conducted in a specialised NIPPV unit. Consecutive patients admitted for ARF requiring NIPPV were assessed by a psychiatrist for presence of delirium using the Diagnostic and Statistical Manual Version IV (DSM-IV). APACHE II score, co-morbidities-, and lung function were also assessed. Patients were followed until their deaths for a minimum of 1 year. Univariate and multivariate Cox's regression analyses were performed to explore predictive factors for death. RESULTS: A total of 153 subjects were recruited, 49 (32.0 %) of whom had delirium. On univariate analysis, higher APACHE II score, lower BMI, presence of delirium, higher Charlson's co-morbidity index but not FEV1 were associated with earlier death. On multivariate analysis, delirium (HR 4.4; 95 % CI 2.6-7.4; p < 0.001) and lower BMI (HR 0.92; 95 % CI 0.86-0.98; p = 0.013) were independently associated with earlier death within 1 year. CONCLUSIONS: There is a high prevalence of delirium in patients requiring NIPPV. The presence of delirium is a strong predictor of mortality. There is strong need to identify and manage these high-risk patients to improve their mortality. The collaboration between psychiatrists and physicians should be strengthened.

Pathogen Surveillance in Swallows (family Hirundinidae): Investigation into Role as Avian Influenza Vector in Eastern Canada Agricultural Landscapes.

First detected in Atlantic Canada in December 2021, highly pathogenic avian influenza virus (HPAIV) subtype H5N1 clade 2.3.4.4b, A/Goose/Guangdong/1/96 lineage, has caused massive mortality in wild birds and domestic poultry in North America. Swallows (Hirundinidae), abundant in North American agricultural ecosystems, have been proposed as possible (bridge) species for HPAIV transmission between wild and domestic birds. We aimed to seek evidence of the potential role of swallows in bridging AIV infection between wild bird reservoirs and poultry flocks in eastern Canada. During a wide-scale outbreak of HPAIV in wild birds and poultry farms across eastern Canada, 200 samples were collected from swallow breeding sites in the Canadian provinces of New Brunswick, Nova Scotia, Ontario, and Quebec, June-August 2022. Samples came from Barn Swallow (Hirundo rustica; n=142), Tree Swallow (Tachycineta bicolor; n=56), and Cliff Swallow (Petrochelidon pyrrhonota; n=2) nests. All samples tested negative for AIV, suggesting that HPAIV and low pathogenic AIV (LPAIV) strains were probably not circulating widely in swallows during the 2022 breeding season in eastern Canada; thus swallows may present a low risk of transmitting AIV. Within a management context, these findings suggest that removing nests of Barn Swallows, a species at risk in Canada, from the exterior of biosecure domestic poultry facilities may not significantly reduce risks of HPAI transmission to poultry.

Avian influenza viruses in wild birds in Canada following incursions of highly pathogenic H5N1 virus from Eurasia in 2021-2022.

Following the detection of novel highly pathogenic avian influenza virus (HPAIV) H5N1 clade 2.3.4.4b in Newfoundland, Canada, in late 2021, avian influenza virus (AIV) surveillance in wild birds was scaled up across Canada. Herein, we present the results of Canada's Interagency Surveillance Program for Avian Influenza in Wild Birds during the first year (November 2021-November 2022) following the incursions of HPAIV from Eurasia. The key objectives of the surveillance program were to (i) identify the presence, distribution, and spread of HPAIV and other AIVs; (ii) identify wild bird morbidity and mortality associated with HPAIV; (iii) identify the range of wild bird species infected by HPAIV; and (iv) genetically characterize detected AIV. A total of 6,246 sick and dead wild birds were tested, of which 27.4% were HPAIV positive across 12 taxonomic orders and 80 species. Geographically, HPAIV detections occurred in all Canadian provinces and territories, with the highest numbers in the Atlantic and Central Flyways. Temporally, peak detections differed across flyways, though the national peak occurred in April 2022. In an additional 11,295 asymptomatic harvested or live-captured wild birds, 5.2% were HPAIV positive across 3 taxonomic orders and 19 species. Whole-genome sequencing identified HPAIV of Eurasian origin as most prevalent in the Atlantic Flyway, along with multiple reassortants of mixed Eurasian and North American origins distributed across Canada, with moderate structuring at the flyway scale. Wild birds were victims and reservoirs of HPAIV H5N1 2.3.4.4b, underscoring the importance of surveillance encompassing samples from sick and dead, as well as live and harvested birds, to provide insights into the dynamics and potential impacts of the HPAIV H5N1 outbreak. This dramatic shift in the presence and distribution of HPAIV in wild birds in Canada highlights a need for sustained investment in wild bird surveillance and collaboration across interagency partners. IMPORTANCE: We present the results of Canada's Interagency Surveillance Program for Avian Influenza in Wild Birds in the year following the first detection of highly pathogenic avian influenza virus (HPAIV) H5N1 on the continent. The surveillance program tested over 17,000 wild birds, both sick and apparently healthy, which revealed spatiotemporal and taxonomic patterns in HPAIV prevalence and mortality across Canada. The significant shift in the presence and distribution of HPAIV in Canada's wild birds underscores the need for sustained investment in wild bird surveillance and collaboration across One Health partners.

The perceived rehabilitation needs of people with schizophrenia in Hong Kong: perspectives from consumers and care-givers.

A quantitative survey was conducted to investigate the perceived rehabilitation needs based on people with schizophrenia and their caregivers. A total of 194 persons with schizophrenia and 83 caregivers were recruited by convenience sampling to complete the two newly developed questionnaires for this purpose which included the Perceived Rehabilitation Needs Questionnaire for People with Schizophrenia and the Perceived Rehabilitation Needs Questionnaire for Caregivers towards People with Schizophrenia respectively. The findings deepened the understanding of this area. Some policy and service development suggestions for mental health strategies in Hong Kong and the Asian-Pacific region were made.

Development and validation of perceived rehabilitation require questionnaires for caregivers of people with schizophrenia.

OBJECTIVE: This study aimed at developing and validating the Perceived Rehabilitation Needs Questionnaires for Caregivers (PRNQ-Cs) of people with schizophrenia. METHODS: The items of PRNQ-C were generated based on focus group discussion and literature review. A validation study was conducted to examine its psychometric properties among 98 caregivers who were recruited via convenience sampling. RESULTS: Through the use of direct oblique rotation, exploratory factor analysis yielded an eight-factor solution which accounted for 64.39% of the total variance. Its internal consistency and test-retest reliability were satisfactory. CONCLUSION: Through cross-cultural validation, the PRNQ-C is applicable in other Chinese communities with huge population of schizophrenia.

Development and initial validation of Perceived Rehabilitation Needs Questionnaire for people with schizophrenia.

PURPOSE: The Perceived Rehabilitation Needs Questionnaires for people with schizophrenia (PRNQ-S), a culturally relevant and multi-faceted assessment tool for measuring perceived needs of people with schizophrenia, was developed and initially validated. METHODS: A total of 43 participants including people with schizophrenia, their caregivers, and mental health professionals were recruited for six rounds of focus group discussion to identify issues pertaining to rehabilitation needs of schizophrenia. Results were then used to develop PRNQ-S. An initial validation study among a convenience sample consisting of 219 people with schizophrenia was conducted to examine its psychometric properties. RESULTS: Exploratory Factor Analysis yielded a seventeen-factor solution accounting for 70.7% of the total variance which resulted in a 75-item PRNQ-S. The instrument had excellent internal consistencies and intra-rater reliability. CONCLUSIONS: The PRNQ-S has been developed and psychometrically tested in Hong Kong. It can be used to assess perceived rehabilitation needs for individuals with schizophrenia in Hong Kong. Upon further validations, it may be applied in other Chinese societies such as Singapore and the mainland. Similar research methodology can also be used for assessing needs in other types of psychiatric disability groups.

Data on the first functionally-annotated de novo transcriptome assembly for North American flying squirrels (genus Glaucomys).

We report the first functionally-annotated de novo transcriptome assembly for North American flying squirrels (genus Glaucomys). RNA was extracted from tissue samples obtained from two northern flying squirrels and two southern flying squirrels sampled from Ontario, Canada, and sequenced on an Illumina paired-end sequencing platform. We reconstructed 702,228 Glaucomys transcripts using 193,323,120 sequence read pairs and captured sequence homologies, protein domains, and gene function classifications. Introgressive hybridization between northern (Glaucomys sabrinus) and southern flying squirrels (G. volans) has been observed in some areas of North America. However, existing molecular markers lack the resolution to discriminate late-generation introgressants and describe the extent to which hybridization influences the Glaucomys gene pool. These genomic resources can increase the resolution of molecular techniques used to examine the dynamics of the Glaucomys hybrid zone.

Operationalization of the SAMHSA model of recovery: a quality of life perspective.

PURPOSE: To test empirically the Substance Abuse and Mental Health Services Administration (SAMHSA) recovery model. METHODS: Two hundred and four attendants aged 18-60, with schizophrenia spectrum disorder, from two participating outpatient clinics were interviewed with a number of inventories, including health-related quality of life measure (WHOQOL-BREF (HK)). Canonical correlation analysis was performed on two sets of variables (SAMHSA recovery components and QoL domain scores). RESULTS: There were significant correlations between most recovery components proposed in the SAMHSA recovery statement and the health-related quality of life measure. Age, duration of untreated psychosis, the degree of social support, the interaction of singlehood and the number of confidants, engagement in competitive careers, and the duration of participation in community support services were all found to be important predictors. CONCLUSIONS: The SAMHSA consensus statement appeared to contain valid concepts for Chinese subjects. It presented new challenges for psychiatric rehabilitation and reminded the policy makers that there is much more psychiatric rehabilitation can achieve beyond symptom control and patient management. It also demonstrated that resolve and the commitment of resources to combat stigma, develop resilience, and foster patient empowerment were very much needed in Hong Kong and perhaps in Asia and elsewhere.

Recovery components as determinants of the health-related quality of life among patients with schizophrenia: structural equation modelling analysis.

OBJECTIVE: The Substance Abuse and Mental Health Services Administration (SAMHSA) National Consensus Statement on Mental Health Recovery proposed 10 recovery components as guiding principles for fostering recovery among people with severe mental illness. Although researchers have recognized a close association between patient-oriented recovery and health-related quality of life (HRQOL), the relation between the recovery components and patients' self-reported HRQOL is still unknown. The purpose of the present study was therefore to use structural equation modelling to predict HRQOL of schizophrenia outpatients from the recovery components proposed by SAMHSA. METHODS: The recovery status of 201 outpatients with schizophrenia, schizophreniform, or schizoaffective disorder was measured using 12 variables that indicate the outcome of 10 recovery components. Canonical correlation analysis was applied to screen variables that are highly correlated with HRQOL. Valid variables were then used to build a structural model that predicted individuals' HRQOL as indicated by the World Health Organization Quality of Life Measure Abbreviated (WHOQOL-BREF (HK)). RESULTS: The bestfit model was able to explain 80.7% of the variance in WHOQOL-BREF outcome. The model demonstrated significant direct and indirect effects of five recovery components on HRQOL. The effect of psychosocial symptoms on HRQOL was highest (total beta = -0.64), followed by sense of personal agency (total beta = 0.58), sense of optimism (total beta = 0.54), perceived support (total beta = 0.47), and internal stigma (total beta = -0.42). CONCLUSION: The recovery components proposed by the SAMHSA consensus statement provided a useful framework to explain HRQOL of outpatients with schizophrenia. The present model indicated a moderate to large effect of five major recovery components on HRQOL. It showed that patients' perceptions of support, optimism, and personal agency were influenced by psychosocial symptoms and internal stigma. This empirical study supported the use of recovery principles, such as resilience building or mastery-based intervention to improve the QOL of community dwellers with schizophrenia.