Determinants of antiretroviral treatment adherence among patients attending secondary health care facilities in north-east and south-west Nigeria: a comparative study

BACKGROUND

Four decades after its discovery, HIV continues to be a major global public health issue, even with antiretroviral therapy (ART). Strict adherence to ART remains a challenge, with attendant implications for treatment success. This study aimed at comparing ART adherence between north-east and south-west Nigeria.

METHODS

A comparative cross-sectional study was conducted in two regions in Nigeria among 400 HIV/AIDS patients on ART. Data were collected using a pre-tested, semi-structured interviewer-administered questionnaire. Multivariable analysis was performed to determine predictors of ART adherence in the regions. The level of significance was set at 0.05.

RESULTS

The majority of respondents from both the north-east (87.5%) and south-west (92.5%) of Nigeria had good knowledge about ART. The self-reported adherence level was 90.0% in the north-east and 87.5% in the south-west. Predictors of ART adherence in the north-east were knowledge about ART (AOR 9.949; 95% CI 2.009-49.284) and transport costs to the clinic (AOR 0.177; 95% CI 0.047-0.661). In the south-west, education (AOR 0.198; 95% CI 0.047-0.832) and knowledge of ART (AOR 8.945; 95% CI 1.749-45.751) were identified as predictors of ART adherence.

CONCLUSION

In both regions, knowledge about ART was appreciable, but adherence was sub-optimal. Strategies to support adherence should be tailored to specific predictors in each region.

Knowledge and utilisation of National Health Insurance Scheme among adult patients attending a tertiary health facility in Lagos State, South-Western Nigeria

Background

Despite the creation of the National Health Insurance Scheme (NHIS) by the Nigerian government, most Nigerians are not covered by the scheme.

Aim

The aim of this study was to assess the knowledge and utilisation of NHIS among adult patients who attended a tertiary health facility in Lagos state, South-Western Nigeria.

Setting

Outpatient clinic, Lagos State University Teaching Hospital, Ikeja, Lagos.

Methods

A descriptive cross-sectional study of 487 respondents recruited using a multi- stage sampling method. Data were collected using pretested semi-structured self-administered questionnaires, and analysis was done using Microsoft Excel 2007 and EPI Info 7 statistical software. Level of significance was set at p < 0.05. Ethical approval was obtained from the Health Research Ethics Committee Lagos State university teaching Hospital.

Results

A total of 487 of the 500 self-administered questionnaires were retrieved and analysed, giving a response rate of 97.4%. The study showed that 80.7% of the respondents had poor knowledge of NHIS, only12.3% of the respondents had registered with the NHIS, and 43.8% of respondents who had not registered with NHIS claimed they do not know where to register. There was a statistically significant association between age and utilisation (p = 0.0007), marital status and utilisation of NHIS (p = 0.016), employment status and utilisation of NHIS (p = 0.001).Most (96%) of those who have utilised NHIS were satisfied with NHIS services.

Conclusion

Majority of the respondents had poor knowledge of NHIS and also majority of those who had registered were satisfied with the scheme. There should be increased awareness campaigns so that all Nigerians can benefit from the scheme.

Health Insurance Knowledge, Attitude and the Uptake of Community-Based Health Insurance Scheme among Residents of a Suburb in Lagos, Nigeria

BACKGROUND

Out of pocket payment for health services in the midst of financial hardship is a major contributor to poor access to healthcare in Nigeria with the resultant poor health indices. Towards the goal of Universal Health Coverage, Community Based Health Insurance (CBHI) was introduced in addition to the National Health Insurance Scheme but with minimal impact and utilization.

OBJECTIVE

The objective of this study was to assess health insurance-related knowledge and attitudes and to examine the uptake of CBHI.

METHODS

This was a descriptive cross-sectional study. A multi-stage sampling method was used to select 419 respondents from the Ajeromi-Ifelodun community. A semi-structured interviewer-administered questionnaire was used to collect data for the study. Data analysis was done using Microsoft Excel and Epi-Info 7.1.

RESULTS

Most of the respondents (80.2%) had not heard of Community-Based Health Insurance and only about 9% of respondents had good knowledge about it. However, most (62.5%) of the respondents had a positive attitude towards health insurance generally. Only 4.5% of the respondents were enrolled in the CBHI scheme and had paid their premium up to date. There was a significant association between the respondents' knowledge and their uptake of the scheme (<0.001), and also between their attitudes and uptake (p = 0.002).

CONCLUSION

This study suggests that for CBHI to be successful, certain strategies must be implemented towards increasing awareness and knowledge about CBHI. This will in turn increase the uptake of the scheme, a necessary requirement for achieving the goal of Universal Health Coverage.

Health-Related Quality of Life of the Elderly in Institutional Care and Non-Institutional Care in Southwestern Nigeria: A Comparative Study

BACKGROUND

The world population is rapidly ageing and people aged 60 years and above are growing faster than any other age group. In Africa, the most rapid growth of older persons is expected in Western and Northern Africa.

STUDY DESIGN

This was a comparative cross-sectional study of a total of 360 respondents. A multi-stage sampling method was used in selecting 240 respondents in the non-institutional group while all the respondents (120) in the institutional group were included in the study. The data was collected using a pre-tested, semi-structured, interviewer administered quality of life questionnaire (SF-36). Data analysis was done using SPSS version 17.

RESULTS

The respondents in the institutional group were older with a mean age of 78.7±8.8 years as compared to 70.1±8.2 years in the non-institutional group. The mean Health-Related Quality of Life (HRQOL) score was higher (64.5±15.6) in the non-institutional group than in the institutional group (52.6±15.7) and this was statistically significant (p<0.001). After controlling for the effect of other variables, the respondents who belonged to the non-institutional group (OR=2.37, p=0.018); who were female (OR=2.00, p=0.019); engaged in work (OR=4.93, p=0.009) and had no co-morbid condition (OR=7.58, p<0.001) were significantly more likely to have good HRQOL.

CONCLUSION

The non-institutional group had better HRQOL than the institutional group in all the domains except in the body pain domain. It is recommended that programs are tailored to the needs of the elderly in institutions and should be targeted towards improving their quality of life and well-being.

Risk factors for chronic kidney disease among patients at Olabisi Onabanjo University Teaching Hospital in Sagamu, Nigeria: A retrospective cohort study

BACKGROUND

Chronic kidney disease (CKD) is common and often goes undetected and undiagnosed until the disease is well advanced and kidney failure is imminent. It is estimated that approximately 36 million Nigerians suffer from different stages of CKD, as one in seven Nigerians has kidney disease.

METHODS

This research was a retrospective cohort study of 150 cases and 300 controls. Selection of subjects was by a retrospective review of records of in-patients from 2010-2013 in a state teaching hospital. Data was analyzed using Chi-square at 5% level of significance.

RESULTS

Majority of subjects were between ages 20 - 29 years. The mean (SD) age of the cases was 40.6 (14.4) and controls was 38.6 (15.8). Ninety (60%) of the cases and 212(70.7%) of the controls were males (p= 0.023). Almost 87% of the cases and 42% of the controls ingest herbal concoction. Use of bleaching substances was more among the cases 20(13.4%) compared with the controls 2(0.7%), ( p= 0.001). Eight (5.3%) of the cases had family history of CKD while only 1(0.3%) of the control had similar history (p= 0.001). There were more cases (10.7%) with diabetic mellitus compared with the controls (2.7%), (p= 0.001). The number of cases with high blood pressure was more than the number of controls, (p-value <0.001). Sixty-four percent of the cases had history of chronic use of analgesic compared with 10.3% of the controls (p < 0.001).

CONCLUSIONS

CKD is mostly found among men in their productive age, who were either diabetic or hypertensive with history of ingestion of herbal concoction and chronic use of analgesic. Individual should engage in regular medical check, modify their life style while government and health care providers increase awareness and campaign on the causes and risk factors of CKD.