The Nigerian Frontline Medicine Journal (NFMJ) is dedicated to advancing medical knowledge and healthcare practices in Nigeria and beyond. Published biannually since its inaugural issue in 2023, NFMJ prioritizes high-quality, peer-reviewed articles spanning various medical disciplines. Its mission includes promoting open access to ensure broad dissemination of research findings. The journal welcomes original contributions from frontline doctors and healthcare professionals across primary, secondary, and tertiary healthcare facilities, emphasizing health promotion and disease prevention. The publication operates under the copyright of the Faculty of Family Medicine at the National Postgraduate Medical College of Nigeria. It has an ISSN number 2636-6487 and an eISSN number 2354-3310. Despite being a relatively new entrant in the scholarly landscape, NFMJ has maintained its promised frequency of publication, with the latest issue released in November 2023.
Faculty of Family Medicine, National Postgraduate Medical College of Nigeria
Prevalence and Factors Associated with Depression Among Undergraduate Health Students in Usmanu Danfodiyo University, Sokoto, Nigeria
Background Depression is a common mental disorder, it is a significant contributor to the global burden of disease, and has been associated with suicidal tendencies even among students. This study aimed to assess the prevalence and factors associated with depression among undergraduate health students in Usmanu Danfodiyo University Sokoto, Nigeria. Methods A cross-sectional study was conducted among 363 undergraduate health sciences students selected by stratified sampling technique. Data were collected using the Patient Health Questionnaire-9 (PHQ-9). Data were analysed using the IBM SPSS version 22 computer statistical software package. Results The mean age of the respondents was 23.39 ± 3.44 years. About a third, 105 (30.0%) of the 363 respondents were depressed. Of these, 84 (80%) had mild depression, while about a fifth (21%) had moderate to severe depression. The factors that were found to be associated with depression were respondents' course of study, history of major life events, history of chronic illness, having a family or social problem, concerns about future career, staying off campus, not having family support, not engaging in regular physical exercise, and having less than 50% punctuality at lectures. Conclusion This study showed a relatively high prevalence of depression among the respondents, and it was associated with their social lifestyle, medical history, and accommodation problems. The primary care facility in the University and family practice physicians should routinely screen undergraduate health students for depression, and the University management should provide adequate accommodation and promote healthy social lifestyles among them (such as participating in extracurricular activities and engaging in regular physical exercise).
Copyright (c) 2025 Nigerian Frontline Medicine Journal
Burnout Syndrome among Healthcare Workers in a Tertiary Health Centre in Southeast Nigeria
Background: The intensive care unit (ICU) represents the pinnacle of patient care, and subjects healthcare professionals to heightened job-related stress, emotional fatigue, and a diminished sense of personal achievement, collectively known as burnout syndrome. This global phenomenon poses risks and potential impacts on the Quality of Life of healthcare providers. Aim: This study aimed to assess the prevalence of Burnout syndrome (BOS) among healthcare workers in the Intensive Care Units (ICUs) and other selected units in Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi. Methodology: A cross-sectional study was conducted involving 296 consenting participants after approval from the ethics and research committees at NAUTH, Nnewi. They were selected using a multistage sampling method. Data were collected with a structured self-administered questionnaire adopted from the Maslach Burnout Inventory (MBI) and analysed using Statistical Package for Social Sciences (SPSS) version 25.0. The level of significance was set at p < 0.05. Results: The prevalence of burnout among participants was 53.7%. Further analysis of the domains of burnout shows that 34.4% of respondents have a high degree of emotional exhaustion, 18.6% show a high degree of depersonalization, and 52.7% of respondents show a poor degree of personal accomplishment. Female health workers have a higher burnout prevalence, 57.1% than their male counterparts, 48.8%. Conclusion: This study reveals a high prevalence of burnout among healthcare personnel in ICUs and other selected units at NAUTH, with significant emotional exhaustion, depersonalisation, and low personal accomplishment, indicating that many healthcare workers feel emotionally drained, detached from patients, and lack fulfilment in their roles.
Copyright (c) 2024 Nigerian Frontline Medicine Journal
Overcoming the Challenges to Primary Healthcare and Universal Health Coverage in Nigeria: The Pivotal Role of the Family Physician
Background Nigeria, the most populous country in Africa and the leading nation in sub-Saharan Africa, is facing a severe healthcare crisis. Its life expectancy of 62.2 years and other worsening health indicators, such as a maternal mortality rate of 814 maternal deaths per 100,000 live births, highlight a weakened health system. Although Family Physicians are the largest group of physicians in developed countries and have transformed primary healthcare, their role and involvement in Nigeria's health system are not yet fully realised. This review examines the main barriers to effective primary healthcare (PHC) and universal health coverage (UHC), and the role Family Physicians could play in achieving a strengthened PHC system. Methodology We conducted a systematic review of the literature across multiple electronic databases, including AJOL, PubMed, Scopus, and ResearchGate. The findings from the literature review were compiled into a comprehensive report, designed to provide clear and actionable insights. Result The main cause of PHC failure in Nigeria is the shortage of healthcare professionals, especially doctors, to provide necessary care, further worsened by the emigration of professionals seeking better pay and opportunities. Other significant challenges include chronic underfunding, with health expenditure consistently below the 15% target set by the Abuja Declaration, and out-of-pocket expenses making up to 70% of health costs. Infrastructure gaps are extensive, as only about 20% of PHC facilities are fully operational, further strained by critical shortages of water, sanitation, and reliable electricity. A lack of policy direction, poor coordination and implementation among the three tiers of government, insurgency, and banditry in some areas are key factors limiting access. Conclusion Nigeria's progress towards establishing robust PHC and UHC faces a complex journey that requires expanding the insurance scheme to enrol all Nigerians. Increased budgetary allocation to develop and maintain infrastructure, alongside competitive salaries and allowances, will motivate staff and enhance the quality of services. Aligning donor agencies' vertical programmes and reporting systems with the National Health Plan and a unified electronic record system (EMR) will produce better results. Investing in the training and deployment of Family Physicians to lead the PHC team will significantly improve primary healthcare and ultimately help the country achieve UHC.
A Potential Gynaecological Disaster that became Joy: A Case of Misdiagnosed Abdominal Ectopic Pregnancy with Live Baby at Term
Background The incidence of abdominal pregnancy is considerably lower than that of other forms of ectopic pregnancy and becomes life-threatening when it occurs. It has a high maternal mortality rate and foetal mortality rate; however, some abdominal ectopic pregnancies have been carried to term. Case Presentation We present a case of a 30-year-old G2P1+0, 1 alive woman who presented at our health facility at a gestational age of 37 weeks following a fall at home while taking her bath. She underwent an emergency caesarean section due to suspected placental abruption and transverse lie with a live foetus. However, the intra-operative findings revealed an abdominal ectopic pregnancy with a healthy female neonate. The placenta was attached to the uterine fundus and the greater omentum. An omentectomy was performed without compromising the blood supply to the bowels. Also, the loose membranous attachment to the uterine fundus was carefully excised and replaced with a suture. Both the patient and her baby girl were discharged home on the seventh day post-operation without complications. No gross congenital anomaly was detected on the baby. Discussion Live neonate in abdominal ectopic gestation is a rare occurrence, and a high index of suspicion with early diagnosis of abdominal ectopic pregnancy is necessary to avoid a potential maternal disaster. Fortunately, our patient had a favourable outcome despite the missed diagnosis. Conclusion There is a need for improved health resource allocation with training and retraining of radiologists and non-radiology professionals involved in obstetric ultrasound to avoid misdiagnosis, as it occurred in this case.
Prevalence and Pattern of Chronic Musculoskeletal Pain among Older Adults and its Sociodemographic and Pain Intervention Correlates in a Tertiary Hospital in North Central Nigeria
Background Chronic musculoskeletal pain (CMP) is a prevalent condition among older adults globally, contributing significantly to reduced quality of life, functional limitations, and healthcare burden. In low- and middle-income countries like Nigeria, the complexity of managing chronic pain is exacerbated by sociocultural factors, underreporting, and limited access to healthcare services. However, there is a paucity of local data on the prevalence and pattern of CMP in the elderly. The purpose of this study is to determine the prevalence, pattern, and sociodemographic correlates of chronic musculoskeletal pain among older adults attending a tertiary hospital in North Central Nigeria. Methods This was a hospital-based cross-sectional study conducted at the General Outpatient Clinic of the Federal Medical Centre, Bida, between September and November 2022. A total of 244 elderly participants aged ≥ 60 years were recruited using systematic random sampling. Data were collected via interviewer-administered questionnaires, including sociodemographic characteristics and pain-related variables. Analysis was performed using SPSS version 24, with statistical significance set at p ≤ 0.05. Results The prevalence of CMP was 44.7%. Low back pain (36.7%) and knee pain (29.4%) were the most common locations, and most respondents reported mild pain intensity. There were no significant associations between CMP and any sociodemographic factors. However, significant associations were found between CMP and the use of analgesics (p < 0.001), herbal remedies (p < 0.001), and other alternative treatments (p < 0.001). Conclusion CMP is highly prevalent among elderly patients in this setting. While sociodemographic factors showed no significant associations, analgesic and alternative therapy use was widespread. Targeted, culturally sensitive interventions are essential to improve pain management outcomes in this population.
Pattern, Predictors and Satisfaction with Complementary and Alternative Medicine Use among Elderly in a Rural and Remote Community in Southwestern Nigeria
Background Before the advent of conventional medicine, traditional medicine was the mainstay of healthcare in Africa. Health coverage for the elderly is especially important as the percentage of the global population constituted by the elderly is at unprecedented levels and is projected to continue to rise. This group of people are often afflicted by a myriad of diseases, and the concurrent use of orthodox and traditional medicine is not uncommon. The aim of the study is to determine patterns, predictors, and satisfaction with Complementary and Alternative Medicine (CAM) use among elderly citizens in the Pakoto community, Ogun State. Methods This was a cross-sectional study carried out among the elderly in Pakoto community in Ogun State. The study was conducted among 197 respondents selected using multi-stage sampling. An interviewer-administered questionnaire was used to obtain data, which was analyzed using Epi Info software version 7.1. The Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ) was used to retrieve responses from the participants. Level of significance was set at p < 0.05. Results The mean age of the respondents was 70 years. The most used modalities of CAM were herbal therapy (67%) and faith healing (33%). The factors associated with the use of CAM were: being 60–64 years old, being employed, having low income, being single, having a partner as a caregiver, having secondary level education, and having a polygamous or other non-nuclear family type. More than half of the respondents (58.5%) had a positive attitude to CAM use, while 55.8% were satisfied with CAM use. Conclusion The variations and use of complementary and alternative medicine among the elderly in the study area is relatively lower compared to reports from similar studies.
Socio-Clinical Determinants of Pattern of Glycated Haemoglobin among Tuberculosis Patients attending DOTS Clinic in North-Central Nigeria
Background Several factors such as obesity and smoking, among others, have been associated with deranged glycated haemoglobin (HbA1c) in TB patients. Hyperglycaemia, measured by HbA1c, showed a significantly higher risk of unfavourable TB treatment outcomes. This study examined the influence of some factors on HbA1c among TB patients attending the DOTS clinic of the University of Ilorin Teaching Hospital. Methodology A hospital-based cross-sectional study involving 180 consenting TB patients that were selected using systematic sampling technique from February to July 2022. Those with diagnosed Diabetes Mellitus were excluded. Data were collected using semi-structured questionnaires. Blood samples were collected for HbA1c estimation using turbidimetric method. HbA1c was categorized as DM (≥ 6.5%), prediabetes (HbA1c ≥ 5.7%–6.4%) and normal (< 5.7%) using American Diabetes Association criteria. Statistical Product and Service Solutions, version 23, was used to analyse data. P-value was < 0.05. Results The pattern of the HbA1c was normal (75%), pre-diabetes (8.9%), and DM (16.1%). The pattern of HbA1c was significantly associated with smoking (p = 0.037). Logistic regression analysis showed that smoking (OR = 0.240, 95% CI: 0.069–0.826) is less likely to predict suboptimal HbA1c (HbA1c ≥ 5.7%), but physical activity (OR = 1.877, 95% CI: 0.914–3.854) showed that those who are inactive were about two times at risk of developing suboptimal HbA1c. Body mass index, duration of treatment, HIV status, family history of DM, and type of TB had no statistically significant association with HbA1c. Conclusion A quarter of TB patients had deranged HbA1c (pre-diabetes and undiagnosed DM). This suggests the need for regular screening to mitigate the potential effects on their health. Physical activity protects against developing deranged HbA1c, and this emphasizes the need for TB patients to be active.
Association between Gender-Based Violence, Women's Empowerment, and Institutional Delivery among Currently Married Young Women in Sub-Saharan Africa
Background The age group designated as young people—that is from 10–24 years of age is a transition period during which young people experience a variety of changes that influence their needs, identities, and behaviour. Gender-based violence (GBV) is an important public health problem. When combined with a lack of empowerment in women, it could severely constrain decision-making on critical issues such as health care seeking among women. This study examined the influence of GBV and women's empowerment on institutional delivery among currently married young women in sub-Saharan Africa. Methods Secondary data from the latest (2017–date) Demographic and Health Surveys from 11 Sub-Saharan African countries was used. Currently married young women from age 15–24 years were selected, giving a sample size of 22,247. However, only 8,621 respondents were interviewed for violence. Results The results showed the prevalence of GBV to be 35.4%. Less than one fifth of the women were empowered. About 41.9% delivered in a health institution. Binary logistic regression was used to determine how GBV and women's empowerment predict institutional delivery. A statistically significant relationship was seen between emotional and physical GBV (p = 0.002, OR = 0.854, 95% CI: 0.774–0.942) and (p < .001, OR = 0.724, 95% CI: 0.638–0.820) respectively. There was no significant association between sexual GBV and institutional delivery (p = 0.127, OR = 1.198, 95% CI: 0.950–1.510). Total GBV was inversely related to institutional delivery (p < .001, OR = 0.788, 95% CI: 0.719–0.865). The odds of delivering in an institution were twice higher among empowered women (p < 0.001, OR = 2.029, 95% CI: 1.751–2.350). Conclusion The prevalence of GBV is still high in sub-Saharan Africa, and the proportion of empowered young women is alarmingly low, putting them more at risk of gender-based violence. These two parameters have a significant influence on institutional delivery, which has been proven to be an essential tool for improving maternal and child health outcomes.
Modern Technology in Malaria Prevention, Diagnosis, and Treatment
Malaria remains a significant global health challenge, particularly in tropical and subtropical regions. In 2022, an estimated 249 million malaria cases and 608,000 deaths were reported worldwide, with the WHO African Region bearing the highest burden. Nigeria, accounting for 27% of global malaria cases, faces severe public health challenges due to the disease. This review examines the role of modern technology in malaria control, focusing on its impact on surveillance, diagnosis, prevention, and treatment. Web-based platforms, mobile applications, Geographic Informa on Systems (GIS), and machine learning have revolutionized malaria surveillance, enabling real- me data collection, mapping, and predictive modeling. Innovations in diagnostic tools, such as Rapid Diagnostic Tests (RDTs), microscopy, molecular diagnostics, and artificial intelligence (AI), have enhanced diagnostic accuracy and accessibility. Preventive measures, including insecticide-treated bed nets (ITNs), indoor residual spraying (IRS), drone-based technologies, and vaccine development, have significantly contributed to reducing malaria transmission. Artemisinin-based combination therapies (ACTs), mobile health (mHealth) technologies, and AI-driven drug discovery have improved malaria treatment and management. Despite progress, challenges such as drug resistance, insecticide resistance, and limited access to healthcare persist. Continued investment in research, strengthening health systems, and fostering collaboration are essential for achieving malaria elimination. Integra ng modern technologies into healthcare delivery can enhance malaria control efforts, reduce morbidity and mortality, and contribute to a malaria-free world.
Relevance of Safety Netting in Handling Diagnostic Uncertainty in Primary Care
Diagnostic uncertainty is a common occurrence in primary care due to varying degrees of factors which may be patient-related, physician-related, or place of practice-related. Safety ne ng is one of the options available in handling such diagnostic uncertainties. Although there is no consensus on what the contents or components of safety-ne ng advice should be, there are quite some that recur frequently. Safety ne ng is used widely and has been observed in 65% and 90% of consultations in England and Scotland, respectively. Safety ne ng is a key element of the Royal College of General Practitioners (RCGP) curriculum, features multiple consultation models and clinical guidelines, and is recognised as forming part of 'best practice' in primary care. This paper aims to bring this concept to the fore and see how to imbibe it into our primary care training and practice.
Family Support, Clinical Profiles, and Psychiatric Comorbidities among Adult Ambulatory HIV/AIDS Patients In A Tertiary are Centre: A Cross-sectional Study
Background: People living with Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS), [PLWHA], experience more common psychiatric disorders (CPDs) than the general population, and family support has been reported to influence these disorders. Therefore, this study aimed to determine the relationship between family support, respondents' clinical profiles, and CPDs among PLWHA attending highly active antiretroviral therapy clinics of the University of Ilorin Teaching Hospital Ilorin, Kwara State. Methods: This was a hospital-based descriptive cross-sectional study, utilizing semi-structured and structured questionnaires to collect data among 363 respondents between March and May 2019. Family support and CPDs were assessed using Perceived Social Support-Family and Mini International Neuropsychiatric Interview respectively. Anthropometric measurements and CD4 cell count test were also performed. Data were analyzed using SPSS version 21. Chi-square tests were used to compare associations between categorical variables; a p-value < 0.05 was considered statistically significant. Results: Family support was strong in 93.7% of respondents, and there were significant associations between family support and CPDs (depression and anxiety disorder {AD}) [p-values 0.001 and < 0.001]. AD was found to be significantly associated with CD4 counts and WHO HIV disease staging (p-values 0.008 and < 0.001), and Alcohol Use Disorder (AUD) had a significant association with WHO HIV disease staging (p = 0.001). Conclusion: Strong family support was associated with a lower prevalence of CPDs. Family members should be encouraged to offer appropriate and functional social support to PLWHA
Atherogenic Index of Plasma and its Relationship with Cardiovascular Risk Factors Among Adult Patients Attending a Primary Care Clinic in South West Nigeria
Background: Cardiovascular diseases have remained major causes of death globally. Early identification of individuals at risk of cardiovascular disease and appropriate intervention is needed in order to reduce the disease burden. The Atherogenic index of plasma (AIP) defined as logarithm of triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) is emerging as a strong marker in predicting the risk of cardiovascular disease. This study assessed the relationship between AIP and cardiovascular risk factors among adults a ending a primary care clinic in South West Nigeria. Methods: It was a descriptive cross-sectional hospital-based study among 286 respondents who were recruited by systematic random sampling over a period of three month. Venous blood samples were collected for lipid profiles and plasma glucose estimations, respondents blood pressure, anthropometric parameters and AIP were also measured. Data was analyzed using descriptive and inferential statistics. Results: The age of the respondents ranged between 19 to 85 years with a mean age of 48.6 ± 15.8 years. Male to female ratio was 1:1.5. According to the AIP category: 68.5%, 12.4% and 19.1% respectively had low, moderate and high-risk AIP for cardiovascular disease. AIP was significantly associated with hypertension, diabetes mellitus, smoking, alcohol intake, obesity and dyslipidaemia. Diabetes mellitus, Low-density Lipoprotein cholesterol, waist circumference and smoking emerged as independent predictors of higher risk AIP. (OR= 4.28, CI: 1.56 – 11.73; P< 0.05). Conclusion: The study demonstrated a significant relationship between high-risk AIP and several cardiovascular risk factors. The use of AIP in stratifying cardiovascular risk is recommended.
Primary Preventive Medication Use and Risk of Atherosclerotic Cardiovascular Diseases Among Patients with Hypertension and Diabetes Attending Irrua Specialist Teaching Hospital, Irrua Nigeria
Introduction: Atherosclerotic cardiovascular diseases (ASCVD) constitute a significant health burden in Nigeria. Aspirin and Statin though effective, are not routinely used as primary preventive medication in those with increased risk of CVD. The study aimed to determine the association between the use of primary preventive medication (low-dose soluble aspirin and statin) on the risk of atherosclerotic cardiovascular diseases among patients with hypertension and diabetes attending Irrua Specialist Teaching Hospital(ISTH), Irrua, Nigeria. Methodology: This was a descriptive cross-sectional study of 394 systematically selected adult patients aged 18 years and above, visiting the GOPD, who had hypertension or diabetes mellitus. Data was collected using a pretested questionnaire and the Cardiovascular risk was assessed using the Framingham 10-year Risk of General Cardiovascular Disease Score (FRS). Respondents were categorised as low risk (< 10%), intermediate risk (10 to 20%), and high risk (> 20%). Data were entered into an Excel worksheet (2007) and analysed with Stata version 16. Results: The mean age of participants was 53.95±15.47 years. They were mostly females (55.3%), and civil servants (32.74%) with tertiary education (44.67%). The majority of the patients (42%) had a high risk of developing CVD in 10 years. There was a significant association between intake of aspirin (p=0.01 AOR 18.98, CI: 2.61-137.91) and statin (p=0.01 AOR 5.02, CI: 0.48-56.00) and reduced risk of CVD. Conclusion: There was a high risk of developing CVD among the study participants. The use of low-dose aspirin/statin for primary prevention of CDC was associated with risk reduction with those not on low-dose aspirin and statin having a 6 and 14-fold increased risk of developing CVD respectively. Routine prescription of low-dose aspirin and/or statins is recommended for patients with hypertension and/or diabetes except those in whom the medications are contraindicated.
Functional disability among elderly patients attending the General Outpatient clinics of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Background: Population ageing is allied to an increase in chronic diseases and decreased functional independence. This study was conducted to assess the functional status of elderly patients attending the General Outpatient Clinic of Usmanu Danfodiyo Teaching Hospital, Sokoto, Nigeria. Materials and methods: We conducted a cross-sectional study where 319 elderly patients were systematically selected. Structured interviewer-administered questionnaires and functionality assessment tools were used to collect the necessary information. Data were analyzed using IBM SPSS version 21 statistical computer software. Results: The mean age of the respondents was 65±6, 7 years. The majority of the respondents were males (52.4%), Hausa (84.0%) and Muslims (89.7%). About 65.2% had no formal education and 53.2% lived in an extended family se????ng. Disability in ADL was 26.3% and 60.0% for IADL. Conclusion: Functional disability in independent living within one's community is more affected than self-care. Older age is significantly associated with disabilities in both ADL and IADL while education and low income were significantly associated with functional disability in IADL
Burnout Among Health Care Workers and Associated Risk Factors Amidst Covid-19 Pandemic In a Tertiary Health Care Setting
Background: Burnout is a work-related stress syndrome resulting from chronic exposure to stress. Its prevalence is higher in some healthcare workers (HCWs) than others and various factors have been linked. The COVID-19 pandemic was one of these. Objectives: To determine the prevalence and pattern of burnout among HCWs, and its association with individual and organizational factors. Methods: The study was a cross-sectional descriptive hospital-based one conducted at UITH, Kwara, Nigeria. Data was collected from 320 HCWs using self-administered questionnaires from June through August 2022 and a stratified random sampling technique was used The prevalence of burnout was assessed using the Oldenburg Burnout Inventory. The collected data was sorted, coded and entered into the computer for analysis using the SPSS-21. Results were presented using frequency tables and charts. Chi-square was also used to assess the association between burnout and organizational as well as individual factors. The level of significance of this study was set at 5% (p <0.05). Results: The prevalence of burnout in this study was 71% as 227 HCWs had burnout. Among those without burnout, 8% (26) were disengaged, 14% (45) were exhausted and 7% (22) had no burnout. The individual factors that had a statistically significant association with burnout were: the occupation of HCWs, specialty and cadre of doctors. Burnout was highest among doctors with the highest prevalence seen among junior residents (p-value 0.00). Based on speciality, the surgeons experience more burnout compared to others (p=0.00). Among the organizational factors, excessive workload, long working hours, poor remuneration and inadequate personnel had a significant association with burnout. Logistic regression revealed p value <0.05 in these factors. Conclusions: The prevalence of burnout in this study was high. Factors associated with burnout need to be evaluated and modifiable ones controlled, to enhance the well-being of workers.
Binary Regression in Practice-Based Research
The population is ageing globally. Therefore, with an increasing population of older persons in Nigeria, there is socioeconomic inequality with extreme poverty and elder abuse coupled with non-implementation of the adopted and published National Policy on Ageing. In addition, evidence has shown the impact on Nations' workforce, healthcare, and educational system. Other challenges of ageing in Nigeria are ageism, multi-morbidities, changing family dynamics, human rights policy issue and lack of an age-friendly environment. This paper aims to review these challenges witch are diverse and inexhaustible hence, a multipronged approach must be employed to address them.
Management of the Psychological Impact of Acne Vulgaris - A Primary Care Perspective
Treating acne vulgaris can be a frustrating task as most patients desire to have quick relief from the symptoms. Due to disfiguring nature of the disease, most patients suffer psychological problems. Some patients get worried about their physical appearance and become withdrawn. Some patients seek spiritual healing, and they consider it an affliction or as a curse placed on them by perceived enemies. There is a need to discuss the diagnosis, the management procedure, the expected duration of treatment and the side effects of the drugs with the patients, as this will help patients to cooperate with their care. Thus, treating the physical symptoms may be a solution to the psycho-cutaneous problems associated with skin diseases. We present this case report and review of the literature to highlight both the psychological and physical symptoms of Acne vulgaris and its management. This patient was treated with any need for complex psychiatric or psychological tools.
Cardiovascular Risk Factors in HIV-Infected Patients Attending a Health Facility in SouthWestern Nigeria
Background: The introduction of antiretroviral therapy (ART) has transformed the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) pandemic from a deadly disease to a chronic disease. However, recent studies have shown that as the patients live longer, cardiovascular diseases have increasingly emerged as important complications of its treatment. The ongoing expansion of ART programs requires an assessment of patients' risk factors for cardiovascular diseases in resource-poor settings.
Factors Associated with the Uptake of Covid-19 Vaccines Among Adult Residents of Selected Communities in South-West Nigeria
Background: The rate of uptake of COVID-19 vaccines varies from one region of Nigeria to another and is influenced by different factors
The Effects of Psychosocial Counselling on Patient Satisfaction Among Patients with Chronic Illness Attending the General Outpatients' Department (GOPD) of the Jos University Teaching Hospital, Plateau State, Nigeria
Background: Patient satisfaction with health care services especially during consultation is considered an important health care index. This is more peculiar to patients with chronic illness, especially hypertensive and diabetics patients. Studies elsewhere have shown increased patient satisfaction ratings with psychotherapeutic interventions. There is however a paucity of literature on the use the use of
Assessment of the level of use of Long Lasting Insecticide Treated Nets among Pregnant women a ending Antenatal Clinic in a Tertiary Health facility in Osun State, South-west Nigeria
Background: Malaria in pregnancy is a serious health problem in tropical and subtropical regions of the world with dangerous consequences to the mother and threat to the unborn child. An approach currently used for its reduction is the utilization of Long Lasting Insecticide Treated Net (LLIN). Though LLIN has been found to be one of the cheapest and most effective interventions against malaria infection if used consistently and properly, the level of malaria among pregnant women in this region still calls for concern, and the impetus for this study. The purpose of the study was to determine the level of use of LLIN among respondents in Antenatal Clinic (ANC) of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria. This is to identify factors associated with the use or non-use of LLINs to establish its level of acceptance. Methods: It was a descriptive cross-sectional study that used a pre-tested interviewer administered questionnaire to obtain information on the socio-demographic characteristics, gravidity, gestational age, use of LLIN, and factors associated with use or non-use of LLIN. Two hundred pregnant women who a ended the ANC and met the inclusion criteria were recruited. The data was analysed using Statistical Package for Social Science (SPSS). Results: A total of 200 respondents took part in this study and 65.5% of them were found to own LLIN. Among the respondents, 12.5% were consistent users of LLIN, 53.0% were occasional users while 34.5% were non-users. Among the consistent users, a major reason associated with the use of LLIN was the awareness that it could prevent malaria (85.7%). The non-users did not own LLIN and the main reasons given for not having was ignorance (42.0%) and use of doors and windows net (21.7%). Conclusions: The study revealed that the level of use of LLIN among the study respondents was poor, therefore malaria preventive education is strongly recommended for malaria knowledge and adherence to LLIN use in pregnant women.
Assessment of self-monitoring of blood glucose practice among type 2 diabetics a ending General Out-Patient Clinic in a Tertiary health facility in Osun State, South-west Nigeria
Background: Diabetes mellitus (DM) is a chronic non communicable disease that has reached a global pandemic proportion with increasing prevalence, morbidity and mortality, especially in low and middle-income countries. An important component of modern therapy for DM is self-monitoring of blood glucose (SMBG) to inform changes for an improved glycaemic control. However, despite the fact that SMBG is one of the most effective monitoring and control measures for DM, the prevalence of poor glycaemic control among diabetics in this environment still calls for concern, hence the impetus for this study. The purpose of this study was to assess the prevalence and pattern of SMBG practice among adult type 2 diabetics attending General Out-Patient Clinic (GOPC) in Osun State University (UNIOSUN) Teaching Hospital, Osogbo, Osun state, Nigeria. This was to determine the frequency, timing and level of SMBG practice among the participants. Methods: It was a descriptive cross-sectional study that used a pre-tested interviewer administered questionnaire to obtain information on the socio-demographic and clinical characteristics, prevalence and pattern of SMBG practice. One hundred and seventy five adult type 2 diabetics who a ended the GOPC between November 2019 and January 2020 who met the inclusion criteria were recruited. The data was analyzed using Statistical Package for Social Science (SPSS). Results: A total of 175 participants took part in this study and 49.1% of them practiced SMBG. Among the participants that practiced SMBG, 56.9% checked their fasting blood glucose on daily basis while others checked it on weekly or monthly basis. Conclusion: This study revealed that the level of SMBG practice among the study participants was fair with a structured pa ern of practice, therefore advocacy on SMBG practice with emphasis on knowledge of the structured pattern of practice is strongly recommended for improved glycaemic control.
The predictive value of handheld peak expiratory flow metre and IPAG questionnaire as a screening tool for COPD among high-risk patients
Introduction: Chronic Obstructive pulmonary Disease (COPD) is increasing in Africa due to multiple risk factors like smoking and use of biomass fuels'. There are challenges in the diagnosis of COPD at primary care due to scarcity of spirometers. Aim: The objective of the study was to evaluate the predictive value of peak flow rate obtained from a hand-held PEFM and questionnaire as a screening tool of COPD among high risk patients. Methodology: A cross-sectional study was carried out from August to November 2018. One hundred and Ninety (190) participants with risk factors for COPD were recruited at the Family Medicine Department in LASUTH, Lagos State. The history of risk factors, International primary airway group (IPAG) questionnaire scores, Peak Expiratory Flow Rate (PEFR) and Spirometry values captured. The best cut-off for PEFM as a screening tool was assessed using ROC curve. Results: PEFM had a Sensitivity of 82.3%, Specificity of 51.1%, and PPV of 63.2% and NPV of 73.8%. The IPAG questionnaire reported sensitivity (44.8%) and specificity (23.4%) indicating poor detection rates of COPD when used as a screening tool. Combining the use of a questionnaire and peak flow meter, less than half (43.8%) of those with COPD would be identified. .ROC revealed best cut off for PEFR as 79.5% of expected which would give a sensitivity of 81.3% and specificity of 57.7%. Conclusion: The mechanical handheld PEFM was determined to have a high sensitivity and PPV, with moderate NPV making it a useful tool in screening for COPD especially in primary care settings where spirometry may not be available.
Patterns of Abuse among Older Adults in General Outpatients Clinic of UATH Abuja, Nigeria.
Background: Elder abuse refers to any intentional act or neglect that causes harm or distress to an older adult. It affects a significant number of older adults globally and can occur in homes, nursing homes, or assisted living facilities. Abuse can be financial, physical, emotional, or even take the form of neglect. The consequences of elder abuse are usually devastating and may affect the individual's quality of life. This study sets out to assess the abuse among older adults a ending the General Outpatient Clinic and its relationship to social support. Methods: It was a cross-sectional study of 259 participants. The Elder Abuse Suspicion Index (EASI) was used to assess for abuse among the participants. It is a validated tool developed specifically to help primary care physicians detect victims of elder abuse. The Oslo Social Support Scale-3 (OSSS-3) was used to assess social support among the participants. It provides a brief measure of social functioning and covers different levels of social support. Results: At the end of the study, 7.7% of the participants relied on caregivers for their basic activities of daily living, and less than half (37.7%) of the participants had emotional abuse, though it accounted for the highest form of abuse. Physical abuse was reported in 19% of our study participants, while 10.1% experienced financial abuse. Only 2.7% complained of neglect. There was a significant association between social support and emotional abuse (chi-square 13.79, p=0.001) and financial abuse (Chi-square = 11.39, p = 0.003), suggesting that the level of social support is correlated with these forms of abuse. Conclusion: The consequence of elder abuse is severe and can result in psychological trauma. A multidisciplinary approach is needed in the management of abuse in older persons. It is important to raise awareness, provide social support, and implement preventive measures to combat this menace and ensure the well-being and dignity of older adults.
FROM PHYSICIAN-DRIVEN TO PATIENT-DRIVEN HEALTH EDUCATION: THE NEED TO INCORPORATE MOTIVATIONAL INTERVIEWING IN THE MANAGEMENT OF HYPERTENSION IN NIGERIA – A REVIEW
Hypertension and other chronic diseases like heart diseases, diabetes, cancers and chronic lung diseases are a significant cause of morbidity and mortality globally. Management of hypertension has been mainly pharmacological. Non pharmacological management through effective health education on healthy lifestyle modification and medication adherence has been shown to improve outcome in the management of chronic diseases including hypertension. Health education in Nigeria is currently physician driven making it difficult for patient to comply with treatment protocol and follow up. This has led to poor treatment outcome in the management of hypertension and other chronic diseases. Adopting shared decision making (SDM) through the use of motivational interviewing, a patient-driven, physician-directed counselling approach that helps patient resolves ambivalence through collaboration, evocation and autonomy. Motivational interviewing has been used successfully in other countries to effect positive behavioural change and improved health outcome. It has also been shown to improve adoption of healthy lifestyle and medication adherence. When incorporated into primary care practice in Nigeria, it will help improve outcome in the management of chronic diseases like hypertension
The Role of the Family Genogram in assessment of Parent-Young person relationships, the experience from a Family Practice in South-Western Nigeria.
Background: The family a young person belongs to is of much importance in determining his/her future outcome. The parent-young person relationship was assessed using the family genogram. Factors associated with the relationship and how it affects the perceived family function of the young person were also assessed. Method: Two hundred and twenty-one young persons, aged 15 to 24 years, had their genograms constructed as part of family-oriented interviews conducted for family assessment and diagnosis. Relationships between young persons and their parents were categorised as either very close or not very close. Results: Respondents were more likely to be very close to their mothers than fathers 75.4% and 47.7%. First-born children were less likely to be very close to their parents than last-born children, 38.8% vs 50% with fathers and 74.2% vs 86.8% with mothers. Close relationship with either or both parents was significantly related to proper family functioning (p=0.003 with fathers and p=0.021 with mothers). Conclusion: Parent-young person relationship was significantly related to perceived family function in the study. The Family genogram is suggested as a tool for assessing parent-young person relationships.
Assessment of reasons for encounter among elderly patients a ending a tertiary hospital in Southern Nigeria.
Background: Reasons for encounter refer to the reasons why a patient seeks health care. Understanding individual expectations makes it possible for an individualized response that patients value and which determines the effectiveness of treatment. Assessment of reasons for encounter among geriatric patients in a primary care setting may provide an interesting perspective. The aim of this study was to assess the reasons for encounter among elderly patients a ending the Geriatric Clinic of a hospital in southern Nigeria. Methods: A cross sectional study was conducted in which two hundred and fifty new patients aged 65 years and above were recruited over three months. A questionnaire was used to obtain sociodemographic data. Reasons for encounter data was collected using a structured checklist based on second version of the International Classification of Primary Care (ICPC-2-E). SPSS version 18 was used for data analysis. Results: Participants' age ranged from 65 years to 99 years with mean age of 72.3 ± 7.33 years. There were 140 females and 110 males with a female to male ratio of 1.2:1. A total of 1,457 Reasons for encounters were seen among the 250 participants. This gave an average of six reasons for encounter per participant. The top three commonest reasons for encounter among the chapters were related to the musculoskeletal system, digestive system and cardiovascular system. Conclusion: This study shows the frequency and distribution of health complaints in the elderly commonly encountered in primary care. This is a reflection of the individual patients' perceived needs, and priorities regarding their health problem in our practice setting. Contribution: Understanding the reasons for encounter across a primary care population is essential for the development of people-centred health services.
SPIRITUALITY AND ITS ASSOCIATION WITH IMMUNE STATUS, MEDICATION ADHERENCE AND QUALITY OF LIFE AMONG HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PATIENTS ATTENDING ANTIRETROVIRAL CLINIC IN A TERTIARY INSTITUTION NIGERIA
Background: Spirituality has been recognized as a vital social factor influencing public health, particularly in the context of HIV/AIDS. This study aimed to assess spirituality and its association with immune status, medication adherence and quality of life among adult patients living with HIV/AIDS Materials and method: This were a hospital-based cross-sectional study. Spirituality, CD4 count, medication adherence and quality of life were assessed among 412 adult HIV-positive patients a ending the an retroviral clinic recruited by systematic random sampling method. A correlational analysis was used to test for association between continuous variables. Statistical significance was set at P <0.05. Results: There was a significant and increasing positive correlation (r =0.24, p = 0.001; r=0.49, p = 0.001; r =0.73, p = 0.001) between Functional Assessment of Chronic Illness Therapy Spiritual Well-being (FACIT-Sp) scores and CD4+ count. There was a positive but weak correlation between FACIT-Sp scores and the mean medication adherence (r = 0.36, p = 0.045, r = 0.25, p = 0.001). There was also a significant and increasing positive correlation between FACIT-Sp scores and the quality of life of the participants (r = 0.71, p = 0.001, r = 0.73, p = 0.001, r = 0.72 p = 0.001, r =0.69 p= 0.001, r =0.67 p= 0.001, r =0.74, p =0.001, r =0.71 p=0.001). Conclusion: Spirituality was positively associated with the immune status, medication adherence and quality of life of HIV- positive adults in this study. Routine spiritual assessment is recommended as part of the healthcare services offered to HIV-positive adults.
Inappropriate drug use and health-related quality of life among the elderly patients a ending the Family Medicine clinic of a tertiary hospital in south-western Nigeria.
Background and Aim: There is a high incidence of multiple morbidities, the tendency to take many drugs at a time, the use of potentially inappropriate medications (PIM), the use of over-the-counter medications (OTC's) and doctor-shopping among the elderly. This research studied inappropriate drug use (IDU) pa erns and their relationship with the health-related quality of life (HRQoL) in elderly patients. Methods: This was a descriptive cross-sectional study of 322 elderly patients a ending the Family Medicine clinic of a tertiary hospital. The patients were recruited using a systematic sampling method, and their data was obtained using a structured questionnaire that incorporated Beer's criteria and SF 36 questions. Results: The respondents' prevalence of IDU was high (n=284; 88.20%). The frequency of engagement in polypharmacy, the use of OTC drugs, and PIM among the respondents were 177(55%), 137 (42.5%), and 164 (50.9%), respectively. The overall HRQoL of the respondents was found to be good (>50 scores) in seven out of eight domains. The majority of the respondents who had poor HRQoL (n=81; 89.0%) were observed to also engage in IDU. However, the rela onship was not sta s cally significant (X2 = 0.080, p = 0.777). Conclusion and recommendation: A regular medication review by a ending physicians and educating elderly patients and their caregivers on appropriate drug use is recommended.