Adetola M. Ogunbode

Morbidity pattern amongst elderly patients presenting at a primary care clinic in Nigeria

Abstract Background The elderly comprise the fastest-expanding age group globally, with the greatest increase occurring in developing countries. Disease and deteriorating health are implicitly assumed to be associated with ageing, as chronic medical illnesses mostly present with increasing age. Objectives To describe the morbidity pattern of elderly patients presenting at the General Outpatients Clinic of the University College Hospital, Ibadan, Nigeria. Method This was a cross-sectional descriptive study of 500 elderly respondents who presented at the clinic between September 2004 and April 2005. They were interviewed according to the format of the electronic, second revision of the International Classification of Primary Care (ICPC-2-E) questionnaire. Main outcome measurements were the prevalence of various morbidities, self-reported health status and socio-demographic characteristics. Body mass index (BMI) was used to assess respondents’ nutritional status. Results Respondents were found to under-report their actual health problems. The mean ± s.d of self-reported health problems was 1.7 ± 0.9 (range 1–6), while the mean ± s.d of diagnosed morbidities was 2.7 ± 1.4 (range 1–8). The most prevalent morbidities were hypertension (40.0%), cataracts (39.4%) and osteoarthritis (26.8%). The prevalence of anaemia was 8.0% (females = 11.2%; males = 2.6%), and it was significantly associated with gender (p = 0.001). Nutritional status indicated a high prevalence of overweight and obesity (51.8%), which was significantly higher amongst the female respondents than the males (p = 0.001). Conclusion The prevalence of chronic medical illnesses was high amongst the elderly in this setting. In addition, the elderly under-reported their actual health problems. The high prevalence of overweight and obesity amongst the elderly in this setting calls for public health action that advocates lifestyle changes to manage the health of the elderly.

Factors Associated with Insomnia among Elderly Patients Attending a Geriatric Centre in Nigeria

Background. Insomnia is a form of chronic sleep problem of public health importance which impacts the life of elderly people negatively. Methods. Cross-sectional study of 843 elderly patients aged 60 years and above who presented consecutively at Geriatric Centre, University College Hospital, Ibadan, Nigeria. The World Health Organization Composite International Diagnostic Interview was used to diagnose insomnia. We assessed the following candidate variables which may be associated with insomnia such as socidemographic characteristics, morbidities, and lifestyle habits. Statistical analysis was done with SPSS 17. Results. The point prevalence of insomnia was 27.5%. Insomnia was significantly associated with being female, not being currently married, having formal education, living below the poverty line, and not being physically active. Health complaints of abdominal pain, generalized body pain, and persistent headaches were significantly associated with insomnia. Conclusion. The high prevalence of insomnia among elderly patients in this setting calls for concerted effort by healthcare workers to educate the elderly on lifestyle modification.

Prevalence of low back pain and associated risk factors amongst adult patients presenting to a Nigerian family practice clinic, a hospital-based study

Abstract Background Low back pain (LBP) is a common health problem with concomitant disability which has assumed a public health importance in our setting. Objectives The aim of this study was to determine the prevalence of LBP and associated risk factors amongst adult patients attending the General Outpatients’ Clinic of the University College Hospital in Ibadan, Nigeria. Method This was a cross-sectional study of 485 respondents. A semi-structured questionnaire was used to obtain information on socio-demography, lifestyle, occupation and other risk factors associated with LBP. Results There were 288 (59.4%) female and 197 (40.6%) male respondents. The point prevalence of LBP was 46.8%. Occupational activities, previous back injury and tobacco smoking were significant associated factors for the total population. For the female respondents, logistic regression analysis showed that a waist circumference of 88 cm or more, dysmenorrhea, previous back injury and being engaged in an occupation were the most significant factors associated with LBP. However, previous back injury was the most significant factor associated with LBP for the male respondents. Conclusion The prevalence of LBP amongst adult patients in our setting is high, with preventable and treatable predisposing factors. Public health efforts should be directed at educating people on occupational activities and lifestyle habits.

Factors associated with osteoporosis among older patients at the Geriatric Centre in Nigeria: a cross-sectional study

Background: Osteoporosis is a silent disabling clinical condition often attributed to ageing. It is of public health importance because of its complications and attendant morbidity and mortality. Methods: A cross-sectional study was undertaken of 2401 older patients (60 years and above) at the Geriatric Centre, University College Hospital, Ibadan. Candidate variables such as socio-demographic characteristics, anthropometric indices, physical and lifestyle habits were assessed. Bivariate and multivariate analyses were carried out using SPSS 17®. Results: The point prevalence of osteoporosis was 56.9% (males = 43.7% and females = 65.8%). The most significant factors associated with osteoporosis on logistics regression analyses were increasing age, female sex, lack of formal education, lack of engagement in occupational activities and living with relatives/friends. Receiving social support from relatives/friends, non-participation in sporting activities at younger ages, prolonged use of medications for peptic ulcer disease, hospitalisation on or after the age of 60 years and asthenic build were also found to be significant. Yearly increase in age shows a 6.9% (95% CI 5.4–8.4%) increase in the odds of having osteoporosis. Conclusion: The high prevalence of osteoporosis among older persons in this study calls for concerted efforts by the healthcare workers to prevent osteoporosis among older patients.

Profile and correlates of functional status in elderly patients presenting at a primary care clinic in Nigeria

Background Assessing the functional status of elderly patients is central in measuring their health outcome. Little is known about the functional status of elderly patients attending our primary care clinic in Nigeria. Objective To assess the correlates of functional status in elderly patients presenting at the General Outpatient Clinic of the University College Hospital, Ibadan, Nigeria. Method A cross-sectional study of 360 randomly selected patients aged 60 years and above was undertaken to assess their functional status by scoring their basic activities of daily living (BADL) using the Modified Bathel Index. An interviewer-administered questionnaire was used to obtain the socio-demographic data, anthropometric measurements and morbidities of each patient. Results The mean age was 69.1 ± 6.6 years with a female-to-male ratio of 1.9: 1. The prevalence of overall functional disability (defined as when assistance was sought in the performance of at least one of the components of BADL) was 88.3%. The highest prevalence of functional disability was experienced in the area of personal hygiene and grooming (95.3%) and transferring from bed to chair (95.3%). Overall functional disability significantly increased with increasing age (χ2 for trend=14.004, p < 0.0001), living in a polygamous family unit (p = 0.025), and lack of formal education (p = 0.020). Conclusion Functional disability was high amongst the elderly in this setting. Age, education, and living in a polygamous type of family unit had significant influence on the functional status. High premium should, therefore, be placed on considering these factors in reducing functional disability in the elderly.

Magnitude of knee osteoarthritis and associated risk factors among adult patients presenting in a family practice clinic in Nigeria

Background: Knee osteoarthritis is a chronic medical condition of public health importance in this setting. It is mostly diagnosed when preventive measures are no longer practicable due to reliance on the radiological diagnosis. Objectives: To determine the magnitude and risk factors associated with knee osteoarthritis among adult patients presenting at the University College Hospital, Ibadan, Nigeria. Materials and Methods: This cross-sectional study used a semi-structured questionnaire to interview 400 respondents. Knee osteoarthritis was diagnosed clinically using the American College of Rheumatology (ACR) criteria. Results: The point prevalence of knee osteoarthritis was 11.5%. Increasing age, female gender, marital status, low educational status, financial dependency, poor income, obesity, previous knee injury, epigastric pain, peptic ulcer disease, varus deformity of the knee, and poor health status were significantly associated with knee osteoarthritis. Logistic regression analysis showed increasing age (OR = 2. 874, CI = 1. 294-6.381), history of epigastric pain (OR = 57. 044, CI = 1. 693-192.24) and varus deformity of the left knee (OR = 3. 012, CI = 1. 063-8.547) to be the most significant factors associated with knee osteoarthritis. Conclusion: The magnitude of clinical knee osteoarthritis is high among respondents in this hospital-based study. Doctors in primary care should screen patients at first-contact to detect osteoarthritis early and manage appropriately.

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

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

Walking prescription of 10 000 steps per day in patients with type 2 diabetes mellitus: a randomised trial in Nigerian general practice

BACKGROUNDnIn clinical practice, translating the benefits of a sustained physically active lifestyle on glycaemic control in patients with type 2 diabetes mellitus (T2DM) is difficult. A walking prescription may be an effective alternative.nnnAIMnTo examine the effect of a 10 000 steps per day prescription on glycaemic control of patients with T2DM.nnnDESIGN AND SETTINGnForty-six adults with T2DM attending a general outpatient clinic were randomised into two equal groups. The intervention group was given goals to accumulate 10 000 steps per day for 10 weeks, whereas the control group maintained their normal activity habits.nnnMETHODnDaily step count was measured with waist-mounted pedometer and baseline and endline average steps per day. Glycosylated haemoglobin (HbA1c), anthropometric, and cardiovascular measurements were also obtained. An intention-to-treat analysis was done.nnnRESULTSnThe average baseline step count was 4505 steps per day for all participants, and the average step count in the intervention group for the last 4 weeks of the study period was higher by 2913 steps per day (95% confidence interval [CI] = 1274 to 4551, F (2, 37.7) = 18.90, P<0.001). Only 6.1% of the intervention group participants achieved the 10 000 steps per day goal. The mean baseline HbA1c was 6.6% (range = 5.3 to 9.0). Endline HbA1c was lower in the intervention group than in the control group (mean difference -0.74%, 95% CI = -1.32 to -0.02, F = 12.92, P = 0.015) after adjusting for baseline HbA1c. There was no change in anthropometric and cardiovascular indices.nnnCONCLUSIONnAdherence to 10 000 steps per day prescription is low but may still be associated with improved glycaemic control in T2DM. Motivational strategies for better adherence would improve glycaemic control.

Knee osteoarthritis and perceived social support amongst patients in a family medicine clinic

Background: Knee osteoarthritis is a chronic disease affecting the lives of patients and their families, with the family characteristics moderating the illness course. The perceived social support received by a patient helps in determining the health and functionality of the patient. Methods: A cross-sectional study was undertaken of 270 patients with knee osteoarthritis attending a family medicine clinic between January and March 2011. The socio-economic and family characteristics of the respondents were obtained. The Multidimensional Scale of Perceived Social Support (MPSS) was used to assess perceived social support by the respondents, while functional health was assessed using the Ibadan Knee/Hip Osteoarthritis Measure (IKHOAM). Results: The majority (68.8%) of the respondents perceived an adequate level of social support from their family members, majorly from their children. Individuals who perceived strong support from their family (69.9%) and friends (71.6%) had a good health perception at a p-value of 0.002 and 0.037 respectively. The study also showed a statistically significant association between strong perceived family support and high functional health status (p = 0.000). Conclusions: The health perception of patients and their physical functionality was positively associated with strong perceived family support. Families and friends can be effective sources of social support for patients with knee osteoarthritis, which help to promote their health outcomes.

Factors associated with reported snoring among elderly patients attending the geriatric centre in Nigeria.

Introduction Snoring is the major symptom of sleep disordered breathing (SDB) which is of immense public health importance. It is associated with some morbidities and mortality in the elderly. Few studies have addressed this problem in the elderly Nigerians. Methods Cross-sectional study of 843 elderly patients at the Geriatric Centre, University College Hospital, Ibadan, Nigeria. Data were collected on the following candidate variables which may be associated with snoring such as socio-demographic characteristics, morbidities, lifestyle habits and functional disability using Katz index. Anthropometric measurements such as body mass index and neck, waist and hip circumferences were taken. Statistical analysis was done with SPSS 17. Results The point prevalence of reported snoring was 31.2%. Habitual snoring was reported by 24.8%. Snoring was significantly associated with obesity, moderate to severe oropharyngeal crowding, wide neck and waist circumferences in both sexes. Logistic regression analysis showed wide neck circumference (OR = 6.005; 95%CI= 2.150-16.770) among the males and obesity (OR = 2.028; 95%CI= 1.344-3.061) and moderate to severe oropharyngeal crowding (OR = 1.639; 95%CI= 1.057-2.543) in the females to be the most significant factors associated with snoring. Conclusion The high prevalence of snoring among elderly patients in Nigeria calls for concerted effort by healthcare workers to educate the elderly.