West African journal of medicine最新文献

Background: Health-related quality of life (HRQoL) is an important Patient-Reported Outcome Measure (PROM) for evaluating outcomes in patients with chronic diseases such as diabetes mellitus (DM). With the rising prevalence of Type 2 diabetes worldwide, especially in developing countries such as Nigeria, there is a need to study the impact of the disease and its treatment on the quality of life of the patients.

Objectives: The objectives of this study were to assess the HRQoL of persons with type 2 diabetes and determine the medical factors and socio-demographic variables associated with it.

Methods: 150 patients with Type 2 diabetes were recruited for this Institution-based cross-sectional study. Seventy-five (75) age and sex-matched controls were also recruited for the study. A structured questionnaire was used to collect data on socio-demographic and clinical variables. The World Health Organization quality of life-abbreviated tool (WHOQoLBREF) was used to assess the quality of life of the respondents. Physical examination and anthropometric measurements were done according to standard protocols. Samples were collected for fasting blood glucose and HbA1c. Multivariate logistic regression was employed to identify the predictors of HRQoL among persons with type 2 diabetes.

Results: The study population was predominantly females (68.7%) with a female: male ratio of 2:1. The mean (SD) overall HRQoL scores in subjects with type 2 diabetes and control sub-groups were 59.5(11.9) and 66.7(10.9) respectively, (p= <0.001). The mean HRQoL scores across all four domains were also lower in the type 2 diabetic arm compared with the controls. The factors significantly associated with HRQoL were: Age, educational level, level of income, duration of illness, presence of chronic complications, glycaemic control and co-morbidities (p <0.05). Older age and poor glycaemic control were identified as significant predictors of poor quality of life.

Conclusion: The findings from this study indicate that all dimensions of the HRQoL of persons with type 2 diabetes were reduced compared to their age and sex-matched controls. This entails the need for interventions that will address the associated factors, beyond the provision of standard treatments so as to improve the quality of life of these patients.

Background: Developmental delay, characterized by a child's failure to achieve expected milestones in one or more developmental domains, is prevalent in Sub-Saharan Africa, where two-thirds of children under five are at risk, exacerbated by limited early screening.

Objectives: This study assessed the prevalence and factors associated with developmental delay among under-five children in rural and urban areas of Oyo State, Nigeria.

Methods: This comparative cross-sectional study utilizing cluster sampling was used to select 1,839 children aged 3 to 4 years. A semi-structured questionnaire adapted from the Nigeria Demographic Health Survey, the Multiple Indicator Cluster Survey Early Childhood Development Index (MICS ECDI), and a literature review were used to collect data on child demographics, nutritional characteristics, and developmental delay across four domains (physical, social-emotional, learning approach, and literacy-numeracy). Analysis was done using STATA which included descriptive and inferential statistics.

Results: The mean age was 3.5 ± 0.5 years with slight male predominance in both rural (51.1%) and urban (51.4%) areas. Overall developmental delay was comparable in rural (39.8%) and urban (36.6%) areas. Physical delay was the most common (rural: 55.7%, urban: 52.5%), while learning approach delay was the least prevalent (rural: 15.9%, urban: 18.3%). Child's age, wealth quintile and exclusive breastfeeding predicted overall developmental delay in both rural and urban LGAs.

Conclusions: There is little variance in the overall prevalence of developmental delay across rural and urban areas, though it remains prevalent in both settings. While risk factors are similar, tailored interventions are necessary to address them effectively.

Introduction: Access to quality antenatal care (ANC) is essential in reducing high maternal morbidity and mortality, especially in resource-poor countries. One way of ensuring financial accessibility to high-quality ANC services is through health insurance. This study assessed the perceived quality of services among insured and uninsured pregnant women attending the ANC at a tertiary health institution in Sokoto, Nigeria.

Methodology: A comparative cross-sectional study was carried out among 118 pregnant women selected via systematic sampling technique. Data were sought using a validated structured questionnaire and IBM SPSS version 25 was used for data analysis. Statistical significance was set at p < 0.05.

Result: Key socio-demographic variables (age, marital status, educational status) of the respondents were comparable concerning their health insurance status (p>0.05). Duration of registration time was significantly longer among the insured than the uninsured clients (p<0.001), however, time spent in waiting was comparable in both groups (p=0.936). Similarly, the ease of getting prescribed drugs and investigations was higher among uninsured compared to their insured counterparts (p<0.001). Clients in both groups were generally satisfied with the services received at the clinic, and there was no statistically significant difference between the two groups (p>0.05). No factor was found to be significantly associated with clients' satisfaction in both groups (p>0.05).

Conclusion: Insured clients spent considerably longer time in registration, laboratory, and in waiting to get their drugs after prescription. To reduce delay in obtaining investigation and prescribed drugs, a dedicated laboratory and pharmacy need to be provided within the antenatal clinic complex.

Background: Mental health care in Nigeria relies heavily on out-of-pocket payments, creating financial barriers that hinder access. A pilot scheme linked to the National Health Insurance Authority (NHIA) Group, the Individual and Family Social Health Insurance Program (GIFSHIP) was initiated to alleviate these challenges.

Objective: The study sought to assess the NHIA scheme's effectiveness in reducing costs, enhancing clinical outcomes, and improving patient satisfaction relative to traditional payment methods in mental health care, while also evaluating the feasibility of a pilot individual GIFSHIP.

Methodology: The study examined the NHIA scheme over nine months at a tertiary mental health facility in Nigeria, involving patients with various mental health diagnoses eligible for insurance. Data on care costs, in-patient admission rates, and patient satisfaction were gathered through structured questionnaires and hospital records. A comparative analysis was performed between insured and non-insured patients.

Results: Insured patients experienced a significant reduction in financial burden, with monthly out-of-pocket expenses approximately 40% lower than their non-insured counterparts. In-patient admission rates and patient satisfaction were similar across both groups. The hospital's indigent patient fund supported a pilot individual GIFSHIP program for individuals with mental illness. Anticipated cost benefits may enhance service uptake and revenue for the hospital.

Conclusion: The pilot mental health GIFSHIP scheme may alleviate financial pressures on patients and enhance access to quality care. Policymakers and healthcare providers can advocate for similar insurance schemes, particularly in integrated care environments, to foster sustainable and equitable mental health care for all. Keywords: Mental health insurance, GIFSHIP, Nigeria, out-of-pocket payment.

Background: Among frequent healthcare users is a small group called "high-care users", with ≥ 10 hospital visits annually. They consume a disproportionate share of the healthcare budget, and their care is often inappropriate and unnecessary.

Objectives: To assess the prevalence and determinants of persistent high-care (PHC) use (≥ 10 visits in two consecutive years) among National Health Insurance Authority (NHIA) enrollees.

Methods: This cross-sectional study analyzed the data of 380 randomly selected patients attending the NHIS Clinic of Aminu Kano Teaching Hospital between January and June 2022. Using a data sheet, we collected their 2018 and 2019 data on biodata, clinic visit characteristics, diagnoses, and cost of care (medicines and investigations) from their medical records.

Results: There were more females (62.6%); their mean age was 37.5±16.0years. Three-quarters (285/380) of patients visited the clinic with an infectious disease in 2018/2019, while 37.6%(143/380) visited with a cardiovascular disease (CVD). Only 2.6%(10/380) were PHC users in the two years. The median cost of care for PHC users in 2018 was 30,549.0((IQR), 23,454 - 35,280) naira compared to the 10,290.0(5,856-18,079) naira consumed by non-PHC users. The median cost of care in 2019 was 41,238.5(25522-54020) naira (PHC users) versus 9,523.5(4709-19070) naira (nonPHC users). Older age, tribe and having CVD were significantly associated with PHC use; however, having CVD (OR=11.38, 95%CI [1.15 - 112.26], P=0.037) predicted PHC use.

Conclusion: The prevalence of PHC users was low. However, they consumed 3 to 4 times more resources than the other enrollees. More robust studies will be required to ascertain the complete picture in order to provide appropriate interventions needed to reduce inappropriate/unnecessary visits and cost of care.

Introduction: Diabetes and chronic liver diseases such as viral hepatitis C (HVC) are global public health problems. The combination of the 2 increases the risk of cirrhosis and hepatocellular carcinoma.

Objective: The aim of this study was to investigate viral hepatitis C in adult diabetics in referral health centers in Cotonou.

Methods: This was a descriptive and analytical cross-sectional study with prospective data collection from July to October 2023 at the Clinique Universitaire d'Endocrinologie Métabolisme Nutrition of the CNHU-HKM, and at the Banque d'insuline d'Akpakpa. A rapid test was used to diagnose hepatitis C and the C viral load determined by PCR. Hepatic fibrosis was assessed by the APRI (ASAT to platelet ratio Index) score.

Results: A total of 281 patients were included, with a mean age of 60.4±11.2 years, ranging from 22 to 88 years, and a sex ratio of 0.6. Anti-HCV antibodies were positive in 5 patients, for a prevalence of 1.7%, including 2 with detectable HCV RNA PCR (0.7% of the study population). Factors associated with HCV were, in bivariate analysis, hepatic cytolysis (p=0.005), prothrombin level (p=0.015), APRI score (p=0.003) and insulin therapy (p=0.030). In multivariate analysis, surgical history (p=0.045) and insulin therapy (p=0.030) were statistically associated with the presence of anti-HCV antibodies in diabetics.

Conclusion: Viral hepatitis C is fairly common in adult diabetics, especially those with a history of surgery or on insulin therapy. Screening of diabetics for viral hepatitis C would be useful to reduce the morbidity and mortality associated with this association.

Introduction: The effectiveness of Brief Psycho-education (BPE) is well-established among caregivers of adults with mental disorders, this is however not the case among caregivers of children and adolescents with Intellectual disability (ID) due to the dearth of data occasioned by relatively few studies in the area.

Objective: This study assessed the impact of BPE on Caregiver burden (CB) among caregivers of children and adolescents with ID.

Methodology: A single-blind RCT was conducted in the Child and Adolescent Clinic in the Psychiatric Hospital, Benin City. Randomization was done via a central computer system and group allocation via a third party. Family caregivers (n=58) were randomly assigned to intervention (n=29) and control (n=29) groups. Intervention and follow-up periods were 4 weeks each. Weekly BPE in addition to routine care (RC) was administered to the intervention group. The primary analysis was based on 58 participants (n=29; n=29) comparing CB in the two groups at the 4th week and 8th week post-intervention.

Results: Mean follow-up post-intervention showed a significant reduction in overall CB in the intervention group between 0 and 4th week (mean deviation 6.76, p=0.03) as well as, 4th and 8th week (mean deviation 12.35, p<0.001). For the CB dimensions, mean follow-up scores post-intervention reached a significant reduction in the 8th week for financial/physical strain factor (mean deviation 1.8, p=0.02), time/dependence strain factor (mean deviation 2.4, p<0.001), emotional strain factor (mean deviation 1.3, p<0001), uncertainty factor (mean deviation 1.45, p=0.004) and self-criticism factor (mean deviation 1.19, p<0.001).

Conclusion: BPE was superior to routine care in reducing CB among caregivers of Children and Adolescents with Intellectual disability.

Introduction: Perinatal asphyxia is caused by a lack of oxygen to organ systems due to hypoxic or ischemic insult that occurs during labour and delivery. This may lead to multi-organ failure with brain involvement as the major organ of concern.

Case report: We present a 19-day-old neonate referred to our centre with the complaint of inability to suck since birth and multiple seizures that started on the second day of life. He cried little, slept much, and had subnormal body temperature He was delivered via spontaneous vertex delivery at 41 weeks to a 19-year-old primigravida with a prolonged second stage of labour. He had a low APGAR score and was managed for severe perinatal asphyxia at the referral Centre. At presentation, He was conscious, not pale, anicteric, no edema with no dysmorphic features. Anthropometries were normal (weight was 2.8 kg, length 47 cm, OFC 37 cm). Had sutural diathesis, weak primitive reflexes, and hypotonia. No macroglossia or umbilical hernia. The stretched penile length was 2.7 cm. Magnetic Resonance Image showed cerebral and pituitary atrophy with hydrocephalus ex vacuo. Thyroid function test revealed central hypothyroidism and the serum cortisol was low (22.22 nmol/l). He was co-managed by a Paediatric neurologist with antiseizure medications, levothyroxine and hydrocortisone. There was some improvement in his activity and the seizure was controlled, however, hypothermia persisted.

Conclusion: Neonatal hypoxic-ischemic encephalopathy does involve the hypothalamic-pituitary axis and there should be a high index of suspicion.

Background: Maternal mortality remains a significant challenge in Nigeria, where 28.5% of global maternal deaths occur. Barriers such as weak policy environments and lack of product availability hinder the implementation of life-saving interventions. This research aims to establish a cross-country network of experts and champions to promote the adoption of evidence-based MNCNH interventions at scale.

Methods: The AIM-MNCNH partnership involving the African Centre for Excellence in Population Health and Policy, Pathfinder, Centre for Communication and Social Impact, and the Medical Women's Association of Nigeria (MWAN) will engage national and subnational platforms, healthcare providers, policymakers, and community advocates in 16 states. Key interventions include strengthening policy environments, building technical capacity for advocacy, and promoting the availability of innovative maternal health interventions for postpartum haemorrhage (PPH) treatment.

Results: This approach is expected to establish a national network of MNCNH experts, drive high-level political advocacy, and strengthen the policy environment for implementing MNCNH innovations. Preliminary engagements with the National Primary Healthcare Development Agency and governments of the 16 states have yielded results. Key indicators for success will include the number of healthcare workers trained, the coverage of new PPH interventions, and reductions in maternal mortality.

Conclusion: This project provides a strategic approach to scaling evidence-based MNCNH innovations. Successful implementation will contribute to achieving Sustainable Development Goal 3 (SDG 3) and significantly reduce maternal mortality in Nigeria.

Introduction: Antipsychotic-induced dystonia is a neurological side-effect and can be very disabling. Treatment is multidisciplinary, including physiotherapy.

Objective: The aim was to show the contribution of physiotherapy in the management of people suffering from dystonia secondary to antipsychotics.

Method: The Saint John of God Mental Health Centre in Lomé was used as the study setting. This involved a descriptive study about a case of cervical dystonia induced by antipsychotics, from 13 July to 30 August 2020.

Results: Our observation concerned a male patient, aged 55 years, suffering from a persistent delirious disorder, on a poorly documented treatment, admitted for cervical dystonia and persistent delirium. A physiotherapy assessment revealed neck pain rated at 5/10, reduced neck muscle strength, and an inability to keep the neck stable at rest. He was started on olanzapine 20mg tablet a day, haloperidol decanoas injectable 50mg/month, and trihexyphenidyl 5mg tablet in the morning. Physiotherapy treatment consisted of 14 sessions using various techniques including passive-active stretching of the neck and head muscles. The evolution was marked by a significant regression of involuntary neck movements and an improvement in the patient's quality of life.

Conclusion: Physiotherapy should be more involved in the management of dystonia in psychiatric practice.