Soter Ameh

Predictors of health care use by adults 50 years and over in a rural South African setting

Background South Africa’s epidemiological transition is characterised by an increasing burden of chronic communicable and non-communicable diseases. However, little is known about predictors of health care use (HCU) for the prevention and control of chronic diseases among older adults. Objective To describe reported health problems and determine predictors of HCU by adults aged 50+ living in a rural sub-district of South Africa. Design A cross-sectional study to measure HCU was conducted in 2010 in the Agincourt sub-district of Mpumalanga Province, an area underpinned by a robust health and demographic surveillance system. HCU, socio-demographic variables, reception of social grants, and type of medical aid were measured, and compared between responders who used health care services with those who did not. Predictors of HCU were determined by binary logistic regression adjusted for socio-demographic variables. Results Seventy-five percent of the eligible adults aged 50+ responded to the survey. Average age of the targeted 7,870 older adults was 66 years (95% CI: 65.3, 65.8), and there were more women than men (70% vs. 30%, p<0.001). All 5,795 responders reported health problems, of which 96% used health care, predominantly at public health facilities (82%). Reported health problems were: chronic non-communicable diseases (41% – e.g. hypertension), acute conditions (27% – e.g. flu and fever), other conditions (26% – e.g. musculoskeletal pain), chronic communicable diseases (3% – e.g. HIV and TB), and injuries (3%). In multivariate logistic regression, responders with chronic communicable disease (OR=5.91, 95% CI: 1.44, 24.32) and non-communicable disease (OR=2.85, 95% CI: 1.96, 4.14) had significantly higher odds of using health care compared with those with acute conditions. Responders with six or more years of education had a two-fold increased odds of using health care (OR=2.49, 95% CI: 1.27, 4.86) compared with those with no formal education. Conclusion Chronic communicable and non-communicable diseases were the most prevalent and main predictors of HCU in this population, suggesting prioritisation of public health care services for chronic diseases among older people in this rural setting.Background South Africas epidemiological transition is characterised by an increasing burden of chronic communicable and non-communicable diseases. However, little is known about predictors of health care use (HCU) for the prevention and control of chronic diseases among older adults. Objective To describe reported health problems and determine predictors of HCU by adults aged 50+ living in a rural sub-district of South Africa. Design A cross-sectional study to measure HCU was conducted in 2010 in the Agincourt sub-district of Mpumalanga Province, an area underpinned by a robust health and demographic surveillance system. HCU, socio-demographic variables, reception of social grants, and type of medical aid were measured, and compared between responders who used health care services with those who did not. Predictors of HCU were determined by binary logistic regression adjusted for socio-demographic variables. Results Seventy-five percent of the eligible adults aged 50+ responded to the survey. Average age of the targeted 7,870 older adults was 66 years (95% CI: 65.3, 65.8), and there were more women than men (70% vs. 30%, p<0.001). All 5,795 responders reported health problems, of which 96% used health care, predominantly at public health facilities (82%). Reported health problems were: chronic non-communicable diseases (41% - e.g. hypertension), acute conditions (27% - e.g. flu and fever), other conditions (26% - e.g. musculoskeletal pain), chronic communicable diseases (3% - e.g. HIV and TB), and injuries (3%). In multivariate logistic regression, responders with chronic communicable disease (OR=5.91, 95% CI: 1.44, 24.32) and non-communicable disease (OR=2.85, 95% CI: 1.96, 4.14) had significantly higher odds of using health care compared with those with acute conditions. Responders with six or more years of education had a two-fold increased odds of using health care (OR=2.49, 95% CI: 1.27, 4.86) compared with those with no formal education. Conclusion Chronic communicable and non-communicable diseases were the most prevalent and main predictors of HCU in this population, suggesting prioritisation of public health care services for chronic diseases among older people in this rural setting.

Drug Resistance among Pulmonary Tuberculosis Patients in Calabar, Nigeria

Background. This study aimed to determine the pattern of drug susceptibility to first-line drugs among pulmonary TB patients in two hospitals in Calabar, Nigeria. Methods. This was a descriptive cross-sectional study carried out between February 2011 and April 2012. Sputum samples from consecutive TB patients in Calabar were subjected to culture on Lowenstein-Jensen (LJ) slopes followed by drug susceptibility testing (DST). The DST was performed on LJ medium by the proportion method. Results. Forty-two of the 100 Mycobacterium tuberculosis strains were found to be resistant to at least one drug. Resistance to only one drug (monoresistance) was found in 17 patients. No strains with monoresistance to rifampicin were found. Resistance to two drugs was found in 22 patients, while one patient was resistant to both three and four drugs. MDR TB was seen in 4% (4/100). The independent variables of HIV serology and sex were not significantly associated with resistance (P > 0.05). Conclusion. There was a high prevalence of anti-TB drug resistance in Calabar.

Quality of integrated chronic disease care in rural South Africa: user and provider perspectives

The integrated chronic disease management (ICDM) model was introduced as a response to the dual burden of HIV/AIDS and non-communicable diseases (NCDs) in South Africa, one of the first of such efforts by an African Ministry of Health. The aim of the ICDM model is to leverage HIV programme innovations to improve the quality of chronic disease care. There is a dearth of literature on the perspectives of healthcare providers and users on the quality of care in the novel ICDM model. This paper describes the viewpoints of operational managers and patients regarding quality of care in the ICDM model. In 2013, we conducted a case study of the seven PHC facilities in the rural Agincourt sub-district in northeast South Africa. Focus group discussions (n = 8) were used to obtain data from 56 purposively selected patients ≥18 years. In-depth interviews were conducted with operational managers of each facility and the sub-district health manager. Donabedian’s structure, process and outcome theory for service quality evaluation underpinned the conceptual framework in this study. Qualitative data were analysed, with MAXQDA 2 software, to identify 17 a priori dimensions of care and unanticipated themes that emerged during the analysis. The manager and patient narratives showed the inadequacies in structure (malfunctioning blood pressure machines and staff shortage); process (irregular prepacking of drugs); and outcome (long waiting times). There was discordance between managers and patients regarding reasons for long patient waiting time which managers attributed to staff shortage and missed appointments, while patients ascribed it to late arrival of managers to the clinics. Patients reported anti-hypertension drug stock-outs (structure); sub-optimal defaulter-tracing (process); rigid clinic appointment system (process). Emerging themes showed that patients reported HIV stigmatisation in the community due to defaulter-tracing activities of home-based carers, while managers reported treatment of chronic diseases by traditional healers and reduced facility-related HIV stigma because HIV and NCD patients attended the same clinic. Leveraging elements of HIV programmes for NCDs, specifically hypertension management, is yet to be achieved in the study setting in part because of malfunctioning blood pressure machines and anti-hypertension drug stock-outs. This has implications for the nationwide scale up of the ICDM model in South Africa and planning of an integrated chronic disease care in other low- and middle-income countries.

Factors associated with appropriate home management of uncomplicated malaria in children in Kassena-Nankana district of Ghana and implications for community case management of childhood illness: a cross-sectional study

BackgroundHome management of uncomplicated malaria (HMM) is now integrated into the community case management of childhood illness (CCM), an approach that requires parasitological diagnosis before treatment. The success of CCM in resource-constrained settings without access to parasitological testing significantly depends on the caregiver’s ability to recognise malaria in children under five years (U5), assess its severity, and initiate early treatment with the use of effective antimalarial drugs in the appropriate regimen at home. Little is known about factors that influence effective presumptive treatment of malaria in U5 by caregivers in resource-constrained malaria endemic areas. This study examined the factors associated with appropriate HMM in U5 by caregivers in rural Kassena-Nankana district, northern Ghana.MethodsA cross-sectional household survey was conducted among 811 caregivers recruited through multistage sampling. A caregiver was reported to have practiced appropriate HMM if an antimalarial drug was administered to a febrile child in the recommended regimen (correct dose and duration for the child’s age). Binary logistic regression was used to determine factors associated with appropriate HMM.ResultsOf the 811 caregivers, 87% recognised the symptoms of uncomplicated malaria in U5, and 49% (n = 395) used antimalarial drugs for the HMM. Fifty percent (n = 197) of caregivers who administered antimalarial drugs used the appropriate regimen. In the multivariate logistic regression, caregivers with secondary (OR = 1.71, 95% CI: 1.03, 2.83) and tertiary (OR = 3.58, 95% CI: 1.08, 11.87) education had increased odds of practicing appropriate HMM compared with those with no formal education. Those who sought treatment in the hospital for previous febrile illness in U5 had increased odds of practicing appropriate HMM (OR = 2.24, 95% CI: 1.12, 4.60) compared with those who visited the health centres.ConclusionsHalf of caregivers who used antimalarial drugs practiced appropriate HMM. Educational status and utilisation of hospitals in previous illness were associated with appropriate HMM. Health education programmes that promote the use of the current first line antimalarial drugs in the appropriate regimen should be targeted at caregivers with no education in order to improve HMM in communities where parasitological diagnosis of malaria may not be feasible.

Challenges faced by key informants practicing case finding for vision loss in children: the experience in Cross River State, Nigeria

BACKGROUND To identify challenges faced by key informants (KIs) in a childhood blindness and severe visual impairment survey in Cross River State (CRS), Nigeria. METHODS Based on eligibility 742 KIs were selected by their village/clan heads in the 18 local government areas (LGAs) of Cross River State. After training in each LGA, KIs were to identify children with visual problems. KIs used a number of methods to identify children with vision loss. After the case detection period, KIs were requested to bring children suspected of vision problems to a central site for examination. Following this, an interviewer-administered semi-structured interview was used to obtain information from the KIs. Thematic content analysis was used to identify these challenges. RESULTS Among the 742 KIs, 642 did not provide any comment on challenges during interview; 100 KIs reported challenges. Major challenge themes identified were issues related to the family of the child and issues related to operational conditions, principally transportation, communication, and incentives. CONCLUSIONS It is likely that challenges were under-reported. Research is needed to understand why some parents feel stigmatized by having children with vision problems. Community based programmes need to strengthen community awareness, address trust issues, and ensure transportation and communication are improved in order to enhance programme success.

HIV-related knowledge, attitude and practices of healthy adults in Cross River State Nigeria: a population based-survey

Introduction Human Immunodeficiency Virus (HIV) remains a global health problem disproportionately distributed across Nigeria. Cross river state (CRS), a tourist state, located in the Niger delta, has one of the highest prevalence rates. There is evidence that poor knowledge and stigmatization are obstacles to achieving universal access to HIV prevention programs. The objective of this study was to determine the Knowledge, Attitude and Practice (KAP) of HIV among adults resident in CRS, Nigeria. Methods A cross sectional descriptive survey design was employed. A total of 1,620 healthy adults were recruited. KAP towards HIV was assessed using a structured pre-tested questionnaire. Categorical variables were described as frequencies and continuous variables as median and interquartile range. Kruskal-Wallis test was used to determine relationship between variables and median KAP scores. P value < 0.05 was considered significant. All analyses were performed using Stata 12 statistical package. Results A total of 1,465 respondents completed the questionnaire correctly giving a response rate of 91%. The M: F ratio was 1:1.8. The median age was 38 years. Majority was married and had formal education. Knowledge of HIV and common routes of transmission was high (>80%). However, misconception that HIV can be transmitted through hugging, hand shake, mosquito bites and witch craft was also common (> 60%). The overall attitude and practice towards persons living with HIV infection was poor. Conclusion This study showed misconceptions in the knowledge and consequences of HIV infection which is associated with negative attitude towards persons living with HIV.

Acceptability of focused antenatal care by antenatal clinic attendees in Obio Cottage Hospital, Port Harcourt, Nigeria

Abstract Introduction: Focused antenatal care (FANC), based on fewer goal-oriented visits, is the WHOs recommended care for pregnant women. The objectives of the study were to assess the acceptability of FANC and

Neuropsychiatric Impairment among Patients with Sickle Cell Anemia

Sickle cell anemia (SCA) is an inherited disorder of hemoglobin. Each year over 150,000 children in Africa are born with SCA. Cognitive impairment is a common complication of SCA. This case-control study evaluated cognitive function in 41 adolescents and adults with SCA and an equal number of healthy demographically matched controls using the community screening interview for dementia (CSID), Trail Making Test A (TMTA), Saint Louis University Mental Status examination (SLUMS), and Mini Mental State Examination (MMSE). Mood (anxiety and depression) was assessed using the Hospital Anxiety and Depression Scale (HADS). The controls had better total scores on all screening instruments; however, the difference between their performance and that of the SCA adults was not statistically significant; SLUM (p = 0.179), TMTA (p = 0.359), MMSE (p = 0.241), and CSID (0.494). On specific task, the controls performed significantly better based on SLUM (naming), p = 0.016; SLUM (repetition), p = 0.015; SLUM (recall), p = 0.003; and CSID (language expression), p = 0.001. The systolic blood pressure (SPB) was inversely correlated with the MMSE scores (p = 0.009). In addition, there was direct linear correlation between the creatinine levels and the MMSE scores (p = 0.009). The proportion of SCA patients compared with the controls that had abnormal mood were anxiety (7.3% vs. 4.9%), borderline anxiety (17.1% vs. 4.9%), depression (2.4% vs. 2.4%), and borderline depression (14.6% vs. 2.4%). SCA was associated with an increased prevalence of cognitive impairment in adults when compared to controls. SCA is associated with a higher proportion of mood abnormalities.

HIV-Related Knowledge, Attitude and Practices of Healthy Adults in CrossRiver State Nigeria: A Population Based-Survey

Background: Human immunodeficiency virus (HIV) remains a global health problem disproportionately distributed across Nigeria. Cross River State (CRS), a tourist state, located in the Niger delta, has one of the highest prevalence rates. There is evidence that poor knowledge and stigmatization are obstacles to achieving universal access to HIV prevention programs. Objective: The aim of this study was to determine the Knowledge, Attitude and Practice (KAP) of HIV among adults resident in CRS, Nigeria. Methods: A cross sectional descriptive survey design was employed. A total of 1,620 healthy adults were recruited. KAP towards HIV was assessed using a structured pre-tested questionnaire. Categorical variables were described as frequencies and continuous variables as median and interquartile range. Kruskal-Wallis test was used to determine relationship between variables and median KAP scores. P value 80%). However, misconception that HIV can be transmitted through hugging, hand shake, mosquito bites and witch craft was also common (>60%). The overall attitude and practice towards persons living with HIV infection was poor. Conclusion: This study showed misconceptions in the knowledge and consequences of HIV infection which is associated with negative attitude towards persons living with HIV.

Uptake of family planning services among women of reproductive age in Edo North senatorial District, Edo State, Nigeria

Introduction: Inadequate provision of family planning and contraceptive services contributes immensely to the worldwide burden of maternal and child morbidity and mortality. Objectives: To assess the uptake of family planning services and its determinants among women of reproductive age group in Edo North Senatorial District, Edo State. Methodology: A descriptive cross-sectional study was carried out. Respondents were selected using multi-stage sampling technique. Questionnaires and observational checklists were used for data collection. Data were analyzed using SPSS version 17. Results: A total of 340 respondents and 15 primary health care facilities were assessed in this study. Sixty percent of the respondents had at least secondary education. The choices of contraceptives were as oral contraceptive pills (OCP) (77.0%), condoms (75.8%), and injectables (56.2%). The predictors of uptake of contraceptives were as marital status (odds ratio [OR] =0.283, 95% confidence interval [CI]: 0.108, 0.746), monthly income (OR = 0.628, 95% CI: 0.491, 0.802), and respondents residence (OR = 0.504, 95% CI: 0.296, 0.859). Conclusion: Uptake of family planning services was higher than both the national and Edo State average values. The determinants of uptake of these services were, marital status, monthly income, and respondents′ residence. The state and local government should increase the availability of family planning services in all the communities and create awareness among the single and unmarried women for improved uptake.