Ibrahim Sebutu Bello

Prevalence of chronic kidney disease in a Nigerian family practice population

Abstract Background: Chronic kidney disease (CKD) is a global public health problem, with a greater burden and prohibitive cost of care particularly in developing countries. This study determined the prevalence of chronic kidney disease and identified its associated risk factors in patients attending the Family Practice Clinic, Wesley Guild Hospital, Ilesa, Nigeria. Method: Consecutive newly-registered patients who attended the Family Practice Clinic of Wesley Guild Hospital, Ilesa from August 2005 to January 2006 were recruited and studied. Relevant data were collected by using an interviewer-administered questionnaire, and determining the spot urinary ACR (albumin-creatinine ratio) of the subjects by using Microalbustix™ reagent strips and using their serum creatinine concentration. The glomerular filtration rate (GFR) of each subject was estimated using the Modification of Diet in Renal Disease (MDRD) formula. A repeat urine test was done three months after the initial screening to identify subjects with persistent microalbuminuria. Results: The age of the study subjects ranged from 20 to 74 years, with a mean age of 50.52 + 13.03 years. There were 68 males and 182 females in the sample population, showing a male to female ratio of 1:2.7. One hundred and thirteen of the 250 subjects (45.2%) were found to have pathologic albuminuria at the initial screening, while 31 (12.4%) had persistent albuminuria three months later. Also, 51 subjects (20.4%) had estimated low GFR at the initial screening and 26 (10.4%) had persistent low GFR three months later. Significant risk factors for CKD in the study subjects were increasing age, elevated blood pressure, history of diabetes mellitus (DM), habitual intake of analgesics and herbs, and an abnormal waist to hip ratio (p < 0.05). The association between persistent abnormal ACR and low GFR did not reach statistical significance (p = 0.053). Habitual analgesic intake (p = 0.002) and age group (p = 0.0027) were true predictors of CKD among the study subjects. Conclusions: The prevalence of CKD in the study population was high and its association with modifiable risk factors was demonstrated. Family physicians have a unique opportunity to identify and address these factors in their patients. Routine screening for CKD in family practice clinics is indicated to reduce the burden of renal disease in the population.

Sickle cell knowledge, premarital screening and marital decisions among local government workers in Ile-Ife, Nigeria

ABSTRACT Background In Nigeria, as in the rest of equatorial Africa, sickle cell disease (SCD) has its highest incidence and continues to cause high morbidity and early death. The condition is a major public health problem among the black race. The aim of this survey is to determine the level of knowledge about SCD and the factors associated with its prevention among local government workers in Ile-Ife. Method This is a cross-sectional descriptive study of the knowledge about SCD, attitude towards premarital sickle cell screening and marital decisions among local government workers in Ile-Ife, Nigeria, using a self-administered questionnaire. Results 69% of study subjects had poor knowledge of SCD, while attitude towards premarital screening was favourable in 95% of the study subjects. Knowledge and attitude were significantly better among subjects with tertiary education. There was a strong positive association between attitude towards sickle cell screening and a history of undergoing screening or partner screening. Most (86.7%) of the respondents and 74.0% of their partners have had sickle cell screening. One-quarter of married and engaged respondents did not know their partners sickle cell status. One-third to two-thirds of study subjects will continue the relationship with their partner when either or both have haemoglobinopathy. Conclusion This study showed poor knowledge of SCD among the studied subjects. There is a need for more emphasis on health education through programmes promoting sickle cell education. In addition, the development of multifaceted patient and public health education programmes, the intensification of screening for the control of SCD by heterozygote detection, particularly during routine preplacement and premarital medical examinations, and the provision of genetic counselling to all SCD patients and carriers are vital to the identification and care of the couples at risk. These will enhance the capacity of the intending couples to make informed decisions and be aware of the consequences of such decisions. Policies are needed to ensure easily accessible community-wide sickle cell screening and premarital and genetic counselling to achieve the desired decline in new births of children with SCD.

Pattern of depression among patients in a Nigerian family practice population

Abstract Background: This study determines the pattern of depression among patients attending the Family Practice Clinic at Wesley Guild Hospital, Ilesa, Nigeria. Socio-demographic and clinical correlates associated with depression were identified. Methods: Two hundred and fifty (250) newly registered patients who attended the clinic between June and September 2005 were selected by the systematic random sampling method and studied. Relevant data were collected using a pre-tested interviewer-administered questionnaire that incorporated Zungs Depression Scale. Results: The age of the study subjects ranged from 16 to 84 years, with a mean age of 49.66 + 14.95 years. One hundred and forty-nine of the 250 subjects (59.6%) were found to have one form of depression or the other. Of these, one hundred and seven (42.8%) had mild depression, forty (16.0%) had moderate depression and only two (0.8%) had severe depression. Depression was found to be commoner in the age groups from 45 years and above, and there was a significant association between age and depression. There were 74 males and 176 females in the sample population, showing a male to female ratio of 1:2.4. Out of 149 depressed subjects, one hundred and four females (69.8%) had depression, while depression was present in 45 males (30.2%). Forty-seven (87.0%) of 54 subjects with no formal education had depression, while depression was found in 102 (52.0%) of the 196 educated subjects. Low educational status was significantly associated with depression in this study. Only two (0.8%) of the 250 subjects gave a positive family history of psychiatric illness, and these two subjects had mild to moderate depression. The proportion of depressed subjects who lived below the poverty level was significantly greater than that of non-depressed subjects. Substance use was also significantly more common among depressed subjects than the non-depressed group. Conclusion: The proportion of patients with depressive symptoms in family practice clinics is high, and it is highly correlated with socio-demographic factors and low socioeconomic status. Family physicians are hereby enjoined to pay greater attention to patients with these factors, as they are at increased risk of depression. In order to reduce the high proportion of depressive symptoms and its adverse impacts on patients seen in family practice clinics and in the community as a whole, there is a need for effective implementation of poverty-alleviation programmes and universal basic education.

The pattern of malaria infection in under-fives in Ile-Ife, Nigeria

Over 90% of the burden of malaria occurs in sub-Saharan Africa. Children, especially under-fives, are the most vulnerable. In Nigeria, Africas most populous nation, it accounts for 25 and 30% of infant and childhood deaths, respectively. One hundred and seventy-six children who fulfilled clinical and parasitological criteria for the diagnosis of malaria, 26.4% of all under-fives, who presented to the Seventh Day Adventist Hospital in Ile-Ife during the months of May to September 2005 were studied to identify the factors that were associated with severe malaria in the target population. The proportion of children with severe malaria in the study was 17%, while the case-fatality rate was 3.5%. Of the 17 variables examined, high malaria parasite density, non-use of mosquito-bite preventive measures and poverty remained independently and significantly associated with an increased risk for severe malaria. Progress in stemming the burden of malaria depends on accurate knowledge and understanding of the epidemiology and control of the disease in the affected populations.

Reliability of Rapid Diagnostic Tests in the diagnosis of malaria amongst children in two communities in South West Nigeria

Background Prompt treatment of malaria following adequate diagnosis helps to reduce morbidity and mortality in children. Lack of resources and adequate manpower in developing countries make malaria microscopy difficult. The Rapid Diagnostic Test kit (RDT) remains unpopular despite its availability and ease of use because of lack of local research on its effectiveness leading to over-prescription of Artemisinin Combination Therapy (ACT).

Administering medical procedures to patients living with AIDS: how comfortable are physicians?

Background: Feeling of comfort is important for efficient and compassionate care. This study aimed to determine physicians’ level of comfort in administering common medical procedures to patients living with AIDS and to identify the demographic variables that may influence level of comfort. Methods: Residents and house officers (n = 211) in 2 Nigerian teaching hospitals were surveyed by a questionnaire that elicited demographic information and information on physicians’ level of comfort in administering medical procedures. Results: Overall, physicians were very uncomfortable with mouth-to-mouth resuscitation. Invasive procedures evoked a lower level of comfort than noninvasive procedures. Knowing a person living with AIDS influenced the comfort level. Older age and professed willingness to treat persons with AIDS were associated with a higher comfort level. Conclusions: This study reinforced the need to address idiosyncrasies as they relate to the AIDS epidemic and to emphasize ethics and altruistic feelings of responsibility to care for those in need.

Effect of family-oriented interviews on family function of young persons attending the family practice clinic in Oauthc, Ile Ife, south-western Nigeria

The outcome of a young person’s future is affected by the support received from the family. Support that is received is related to the quality of family functioning of the young person. Family-oriented interview assesses the family of a patient who presents for consultation, through the patient. It diagnoses relationship issues in a family and helps in solving them. It may be best suited for the young-person encounter in a clinic as it ensures privacy, an important requirement for young-person care. The study objective was to assess the perceived family function of young persons and the perceived effect on this of family-oriented interview. The study had a quasi-experimental, pre- and post-test design, and the setting was in the family medicine clinic. Family-oriented interview was conducted for 221 young persons after an initial family function assessment. They were each followed up for 12 weeks and family function was reassessed. Perceived family function was significantly associated with very close relationships with the family members, especially fathers and mothers. Family-oriented interview may have significantly improved perceived family function in the study. Family-oriented interview of young persons presenting for medical care is recommended.