Relationship between Lifestyle Indicators and Un-investigated Dyspepsia Among Adult Patients in a Primary Care Setting in Northern Nigeria

BACKGROUND

Un-investigated dyspepsia has remained a common encounter among patients seen in primary care in sub-Saharan Africa. A preventive approach through counselling patients on modifications of lifestyle factors related to dyspepsia could be a cost-effective approach to dyspepsia management in primary care in low- and middle-income settings.

OBJECTIVES

The objectives were to describe the sociodemographic patterns of adult patients with un-investigated dyspepsia in the Family Medicine Clinics, Federal Medical Centre, Gusau, Nigeria, to describe the pattern of lifestyle factors among adult patients with un-investigated dyspepsia, to determine the relationship between lifestyle patterns and un-investigated dyspepsia and to describe the specific food types that precipitate dyspepsia among the respondents.

METHODS

A hospital-based cross-sectional study using the Short Form Leeds Dyspepsia Questionnaire to describe the presence and severity of dyspepsia and the Simple Lifestyle Indicator Questionnaire to describe the lifestyle patterns of participants.

RESULTS

Most respondents (66.9%) have healthy dietary patterns however more respondents 66(52.4%) engaged in unhealthy levels of physical exercise. The Stress level was intermediate in majority of respondents (66.1%). There was no statistically significant association between lifestyle indicators and severity of dyspepsia among the respondents although the linear regression model with p-value < 0.01 and < 0.05, revealed stress as a predictor of dyspepsia in this study.

CONCLUSION

There was no relationship between lifestyle indicators and Uninvestigated dyspepsia among the study participants. However, some specific local foods were identified as precipitants of dyspepsia. Primary care physicians may consider a targeted dietary modification counselling approach in managing patients with uninvestigated dyspepsia.

Prevalence and Factors Associated with Stress, Anxiety and Depression amongst Primary Care Patients with Hepatitis B and C Infections in Nigeria

BACKGROUND

Globally, more than 350 million people live with viral hepatitis, out of which over 20 million are in Nigeria. The prevalence of anxiety, depression and stress among patients with viral hepatitis in the primary care setting is not well established.

OBJECTIVES

The objectives of this study were to determine the prevalence and factors associated with depression, anxiety and stress among hepatitis patients in a primary care clinic in North Central Nigeria using the Patient Health Questionnaire (PHQ2), Generalized Anxiety Disorder (GAD 2) and Kessler 6 scales respectively.

METHODS

This cross-sectional study was carried out among Hepatitis B and C patients attending the Hepatitis Clinic of the Family Medicine Department, Federal Medical Centre Keffi. A total of 123 participants were recruited using a simple random sampling technique. Their sociodemographic and clinical data were collected after which they were screened for depression, anxiety and stress. Data collected was analysed using IBM SPSS.

RESULTS

The mean age of study participants was 38.9±11.6 years. Most of them had hepatitis B infection (89.7%) and were on antiviral medications or liver supplements (45.2%). The prevalence of anxiety, depression and stress among them were found to be 18.9%, 25% and 77.6% respectively. Illness duration and medication use were found to be significantly associated with both depression and stress among them.

CONCLUSION

The prevalence of anxiety, depression and stress is high among adult primary care patients with viral hepatitis in FMC Keffi.

Awareness, Availability and Use of Teaching Aids and Skills Acquisition Materials in Family Medicine Training Centres in West Africa

INTRODUCTION

Teaching aids and skills acquisition tools are rapidly forming an integral part of Family Medicine postgraduate training worldwide. While some training centres in West Africa have made concerted efforts to ensure their use, many still have a lot to improve on. Hence, there is a need to objectively determine its level of awareness, availability, and use in the sub-region.

METHODS

This was a descriptive cross-sectional study involving all consenting Heads of Department and Training Coordinators of all centres with current West Africa College of Physicians Family Medicine accreditation. The Google link to a questionnaire comprising socio-demographic variables, questions on awareness, availability and use of various teaching aids and skill acquisition tools was sent to the respondents via WhatsApp message. Continuous variables were expressed as mean ± standard deviation and categorical variables as frequencies and percentages. Chi-square test and logistic regression analysis were used to determine factors associated with and predictors of availability and use of teaching aids/skills acquisition tools.

RESULTS

The response rate was 107(84.3%) from all currently accredited West Africa College of Physicians Family Medicine training centres. Their mean age was 54±7 years; they were predominantly 93(86.9%) certified as trainers. All the respondents felt the use of teaching aids/skills acquisition materials will enhance learning in their departments. However, most were aware and used traditional resources (97.2%) and non-electronic (96.3%) resources. Only 10 (9.3%) respondents had mannequins for training Resident Doctors.

CONCLUSION

Most Family Medicine Trainers in West Africa are aware and support the use of teaching aids/skills acquisition materials. However, the uptake is currently very low. There is an urgent need for the Postgraduate College and all stakeholders to look into ways of improving the use of teaching aids/skills acquisition materials in the sub-region.

Contributions of family physicians to health care services in Nigeria

In Nigeria, family physicians are doctors with specialised training to manage a broad range of clinical conditions and pathologies when they first present, considering the psychosocial, economic, cultural and environmental context of the individual and his or her family. In Nigeria, family physicians may be found at district hospitals but are more likely to be located at tertiary health care facilities, where their roles in medical education, research and clinical services cannot be overemphasised. Many patients present to tertiary facilities with primary-care problems, bypassing primary and secondary care. They are often seen initially by family physicians in general outpatient clinics, where 70% of all problems are managed without referral to other specialists. These physicians are also in charge of most of the National Health Insurance Scheme (NHIS) clinics nationwide. They are thus the gatekeepers to the majority of tertiary hospital services.

Variation between pragmatic and standardised blood pressure measurements in a Nigerian primary care clinic

Background

A significant difference in the blood pressure (BP) value of a patient taken by different health workers has been a subject of discussion among health workers. This study investigated the variations between usual-care and guideline-concordant BP measurement protocols and evaluated the implications of the disparities on diagnosis and treatment decision.

Methods

A cross-sectional study was conducted among 206 participants. The usual-care and guideline-concordant BP readings taken from each participant by the regular clinic nurses and research-trained nurses, respectively, were obtained.

Results

Majority of the regular clinic nurses following the usual-care protocol used the left arm for BP measurement (59.7%). The systolic BP (SBP) and diastolic BP (DBP) readings were higher on the right arm in 55.3% and 39.2% of the participants, respectively. The mean guideline-concordant BP was 7.67 mmHg higher than the mean usual-care for SBP (p ≤ 0.05) and 7.14 mmHg higher for DBP (p ≤ 0.05). The proportion of participants classified as having hypertension and uncontrolled BP was 11.8% and 15.0% lower when using usual-care BP compared to guideline-concordant BP, respectively. Fifty-one (24.8%) respondents were advised incorrect treatment based on usual-care BP measurement. The Bland-Altman plot showed that limits of agreement were wider than within the 10 mmHg clinical reference range and unacceptable for clinical purposes.

Conclusion

The usual-care and guideline-concordant BP measurement protocols were significantly different, and the disparity had significant consequences on the diagnosis and treatment of hypertension. Health workers should strictly adhere to the guidelines on BP measurement to avoid mismanagement of patients.