Exploring the role of health management information systems in improving accountability arrangements for primary health care delivery in less developed countries: a case of Northern Nigeria

Health management information systems (HMIS) are implemented in less developed countries (LDCs) with the expectation that they will contribute to improving primary health care (PHC) delivery. Information generated through these systems is conceived as an imperative for better decision making processes and strengthening accountability arrangements that underpin the delivery of PHC. Despite strong rhetoric and significant investments to support these systems, most HMIS implementation in LDCs face challenges of poor data quality and weak accountability arrangements that limit their impact on health status. This constitutes a divergence from the instrumentality of predetermined indicators measuring health status performance that do not necessarily reflect the complex reality underlying how poor communities define their health priorities. We therefore highlight that accountability for performance management may indeed detract from the objective of improving the health of the poor and needs to be understood more broadly. This study illuminates the challenges and potential of HMIS implementation through accountability arrangements that are socially embedded in institutions, interactions and interpretations of global and local actors. As such, our primary research question is, “To what extent can HMIS improve accountability arrangements of PHC delivery?” Employing an interpretivist research methodology, we provide perceptions of how interactions between citizens, service providers, bureaucratic and political agents dynamically construct, contest and navigate accountability arrangements underpinning the provision of health care. This understanding has hitherto been limited in the HMIS literature. As a central theme in ICT for Development literature, illuminating these interactions furthers our understanding regarding the potential of HMIS in improving the lives of the poor. National governments, donors and HMIS practitioners will benefit from the practical insights derived from this study especially in relation to reconceptualising HMIS analysis to incorporate contextual and developmental notions of PHC. With relatively limited HMIS research, Northern Nigeria as the empirical context of this study also constitutes a useful contribution to the body of knowledge

The relationship between self-reported Health Status and Spirituality among adult patients attending General Outpatient Clinic of Tertiary Hospital in Ibadan

Background: Spirituality is an important aspect of health that is not always addressed in modern day medical  practice. This is related to lack of clarity about the nature of the concept, however its role in researches and health service provision is being revisited because of the evergreen importance.Objective: To determine the relationship between spirituality and selfreported health status of adult patients attending general outpatient clinic of University College Hospital, Ibadan, Nigeria.Methods: A cross-sectional descriptive study wherein interviewer administered questionnaire was applied on randomly selected 422 eligible and consenting adult patients attending general outpatient clinic of University College Hospital between 1st November, 2010 and 31st January, 2011. Their Spirituality and Heath status were assessed using spirituality scale and self reported health questionnaire respectively.Result: Of all the respondents, 270(64.0%) were females while 152(36.0%) were males with a ratio of 1.8:1, and mean age of 42.8±15.9. The overall mean spirituality score was 125.7 ± 12.1, the maximum obtainable score was 138. A total of 63(15.0%) respondents rated their health as excellent, 114 (27.0%) rated theirs as very good while 150 (35.5%) respondents considered theirs as good. Respondents who rated their health as good had significantly higher mean scores when compared with those who rated theirs as poor or fair (mean difference = 3.347, 95% C I = 0.552 to -6.142 p=0.019)Conclusion: The study revealed that perceived spiritual wellbeing is positively related to the patient’s sense of  general wellbeing. Therefore, there is need to give attention to patient’s spiritual wellbeing during medical encounter in the hospital.Key words: Spirituality, Self-reported health, Spirituality scor

Prescribing pattern of antihypertensive medications in a geriatric center in south western Nigeria

Background: Hypertension is a prominent public health problem, with considerable health consequences. Recommended guidelines encourage use of antihypertensive medications with the best evidence of reducing cardiovascular risk. Data on antihypertensive medications use among older Nigerians is limited.Objective: This study evaluated the antihypertensive medication use among older persons with hypertension in compliance with the Eighth Joint National Committee guidelines (JNC 8).Method: A retrospective cross-sectional study, of older patients diagnosed with hypertension between the 1st January 2017 and 31st December 2017 at the geriatric center, University College Hospital, Ibadan.Results: The mean age was 70.2 ± 7.2 years and 62% were female. The mean number of medications used by the patient was 4.5 ± 1.4. Of the patients, 56% were receiving combination therapy, 42% two drugs and 14% three drugs. Most patients were receiving calcium channel blockers (33.8%), followed by diuretics (29.6%), angiotensin receptor blockers (23.4%) and angiotensin-converting enzyme inhibitors (10.8%). Commonest combination therapy was calcium channel blockers and thiazide diuretics (28.3%), while the commonest multi-morbidities were osteoarthritis (32.7%), diabetes (17.3%) and dyslipidemia (8.7%).Conclusion: This study showed that more than half of older persons with hypertension were on combination therapy, and the most frequently used class of antihypertensive drugs were calcium channel blockers, followed by diuretics. The guidelines and data for black ≥60 years indicate that lower doses of combination therapy are more effective in achieving blood pressure target. Despite the numerous advantages of ACEIs, they remain underutilized.Keywords: Hypertension, older persons, antihypertensive drugs, prescription pattern, Nigeri

Dynamic analysis of large strain deformation of flexible pipes conveying two-phase fluids Part I: linear vibration analysis

This work presents dynamic response of large strain deformed subsea flowlines and jumpers conveying two-phase fluid. Large strain deformation theory is used to analyze the effects of high pressure-high temperature two-phase flow on critical velocity in flexible pipes. Starting with natural frequency of simply supported flexible pipes, corresponding nonlinear transport equations are derived and subsequently expanded using the method of multiple scales perturbation. Frequency response obtained from the linearized leading order equations established that buckling and flutter-like instabilities attend critical velocities. Furthermore, the buckling velocity of transverse pipe decreases with increasing temperature, pressure or tension. Clearly, the transverse buckling velocity is higher in large strain deformation model compared with small strain model. In addition; whereas the critical velocity in the longitudinal direction is independent of temperature, pressure and tension for small strain models; these variables determine the path to failure in large strain deformed pipes.Keywords: Large strain deformation, small strain deformation, simply supported pip

Factors associated with low back pain among cleaners in a tertiary hospital in Nigeria

Objective: To determine the magnitude and factors associated with low back pain (LBP) among hospital cleaners at the University College Hospital (U.C.H), Ibadan.Method: This is a cross-sectional study conducted amongst all the cleaners working at U.C.H, Ibadan. The main outcome measurements were prevalence of LBP, socio-demographic characteristics and description of cleaning activities.Results: One hundred and forty-nine hospital cleaners (136 females and 13 males) with a mean ± age of 34.7 ± 8.5 years were interviewed. The point prevalence of LBP was 77.2%. The respondents worked an average of 8.3 hours (4 -12 hours) each day. Cleaning activities were performed an average of 3 times each day (1 - 6 times). The prevalence of LBP was significantly associated with working more than 8 hours a day (p = 0.031), living above the poverty line (p = 0.021), completion of at least 9 years of formal education (p = 0.027) and not being in marriage (p = 0.003).Conclusion: The high prevalence of LBP among hospital cleaners in our setting is worrisome and efforts should be made by physicians to detect the presence of modifiable factors associated with low back pain among hospital cleaners they encounter during clinical consultations.Keywords: Cleaners; low back pain; risk factors; prevalence

Predictors of physical activity in school attending adolescents in Lagos State, Nigeria

Background Physical activity has been shown to be a significant protective factor for different health outcomes. The World Health Organization (WHO) recommends that children and adolescents should accumulate at least 60 minutes of moderate-to-vigorous-intensity physical activity (MVPA) daily. Africa is rapidly undergoing an unprecedented phase of urbanisation and how to ensure healthy lives for its residents is increasingly becoming an important question. Some of the immediate effects of urbanisation are pressures on existing built environment. Previous reviews have synthesised associations between the built environments and physical activity in children and adolescents, but they have focused on non-African settings. Therefore, the first objective of this PhD study was to present evidence on the built environment constructs that were associated with physical activity among children and adolescents in Africa. Lagos occupies a unique position in West Africa subregion, as the city with the highest rate of urbanisation. As with most cities that are going through urbanisation, inequitable distribution of resources in different areas of the city affect physical activity. The second objective was to determine the proportion of school attending adolescents that reached the recommended MVPA level in Lagos State, Nigeria and to identify the predictors that were associated with reaching the recommended level. And finally, the third objective was to explore the barriers and facilitators of physical activity among school attending adolescents in Lagos State, Nigeria. Methods To achieve the above-mentioned objectives, three inter-related studies were conducted. First, a systematic review, adhering to the JBI methodology, was conducted to synthesise the existing evidence on the association of built environment constructs with physical activity among children and adolescents in Africa. Comprehensive electronic searches of ten databases from inception to 22 October 2021 were conducted to identify relevant published and unpublished studies. Two reviewers independently screened the papers, assessed the quality of the included studies using the JBI standard critical appraisal tool, and extracted data using a pre-piloted form. Where possible, data were synthesised using random effects meta-analyses, with effect sizes reported as mean differences (MD) with 95% confidence intervals (CI). The Grading of Recommendations Assessment, Development and Evaluations (GRADE) was used to assess the certainty of the findings. Second, a cross-sectional study was conducted among a representative sample of 720 adolescents aged 12-19 years from 20 schools in Lagos State, Nigeria in 2020. A validated physical activity questionnaire (Activity Questionnaire for Adults and Adolescents, AQUAA) was administered to assess MVPA and the predictors assessed were socio-demographic variables, anthropometric measurements, sedentary behaviour, self-efficacy, perceived benefits, and perceived barriers. Third, a qualitative study, using semi-structured interviews, was conducted to explore the views and experiences of 21 decision-makers, who were responsible for planning the physical and health education curriculum in secondary schools in Lagos State, Nigeria, on the barriers and facilitators of physical activity in school attending adolescents. Results In the systematic review, of the 10,706 identified records, six cross-sectional studies were included which comprised 4628 children and adolescents. Three of the studies had a high-quality score of 7 out of 8. Seven built environment constructs were reported within the included studies namely, residential density, street connectivity, crime safety, availability of physical activity facilities and infrastructure, walkability, aesthetics, and traffic safety. Three of the constructs were assessed with objective measures. Results from individual studies found significant associations between physical activity and objective measure of traffic safety (Mean difference (MD) 2.63 minutes; 95% Confidence interval (CI) 0.16 to 5.1; one study) and an objective measure of crime safety (MD 2.72 minutes; 95% CI 0.07 to 5.37; one study). No significant associations were found between active transportation and any of the built environment constructs. The GRADE evidence for all the assessed constructs was either low (the built environment constructs may lead to little or no difference in physical activity or active transportation) or very low (it was uncertain whether the built environment constructs affect physical activity). In the cross-sectional study, complete data was provided by 528 adolescents for the study (73% response rate). The recommended MVPA level was reached by 82.8% (95% CI 79.3–85.7) of the participants. Participants spent a median time of 44 (Inter quartile range (IQR) 12.9, 110) minutes of MVPA per day on household-based activities, followed by school-based activities (median 21.4; IQR 4.3, 50.4), active transportation (median 14.3; IQR 0, 35), sport-based activities (median 8.6; IQR 0, 58.9) and leisure-based activities (median 8.6; IQR 1.1, 34.3). Participants in public schools were four times more likely to meet the recommended MVPA level compared to those in private schools (Odds ratio (OR) 3.97, 95% CI 2.46–6.42). In the qualitative study, eight themes were identified and explored. The barriers to physical activity were (i)students’ characteristics (ii) parental objections (iii) no prioritisation of physical activity (iv) insufficient resources and (v) challenges with schools’ initiatives. The facilitators to physical activity were (vi) students’ interests (vii) students’ awareness of benefits and (viii) schools’ initiatives. Conclusion The evidence base for the association between built environment constructs and physical activity in African settings is limited, with no consistent evidence of an association. Therefore, further high-quality studies should be conducted before firm conclusions can be drawn. Findings from the cross-sectional study suggest that a high proportion of school adolescents met the recommended MVPA level in Lagos State, Nigeria. Additionally, our study suggests that interventions for promoting MVPA should be targeted to private schools. Our study’s finding from the qualitative study can help design interventions to increase physical activity among school attending adolescents in Lagos State, Nigeria

Factors associated with undernutrition and overweight in elderly patients presenting at a primary care clinic in Nigeria

Background: Undernutrition and overweight are commonly overlooked health problems of the elderly, often due to the implicit assumption that undernutrition is a rare occurrence in old age and overweight is an invariable consequence of ageing. Method: A cross-sectional descriptive study of 500 patients aged 60 years and above who presented consecutively at the general outpatient department, University College Hospital, Ibadan, between September and October 2009, was undertaken. The main outcome measures were prevalence of nutritional problems (undernutrition and overweight), healthcare utilisation pattern and morbidities. The Mini Nutritional Assessment (MNA) tool was used to assess undernutrition, while body mass index was used to assess body weight. Results: The prevalence of undernutrition and overweight was 7.8% and 54.1%, respectively. Previous hospital admission (p < 0.001) and chronic morbidities like hypertension (p < 0.001), osteoarthritis (p < 0.001) and psychosomatic disease (p < 0.001) were significantly associated with undernutrition, but not with overweight. Logistic regression analysis showed that previous hospital admission (OR = 2.105, 95% CI 1.479-2.996) and hypertension (OR = 0.122, 95% CI 0.048-0.306) were the most important factors contributing to the development of undernutrition. Conclusion: Nutritional problems were prevalent among the elderly in this setting. Co-morbidities in the elderly constitute risk factors to be addressed in order to reduce the occurrence of nutritional problems. Health workers should always assess the elderly for nutritional problems, together with other morbidities with which they may present, and institute appropriate management.Keywords: elderly; primary care, Nigeria; overweight; undernutritio

Predictors of physical activity in school attending adolescents in Lagos State, Nigeria

Background Physical activity has been shown to be a significant protective factor for different health outcomes. The World Health Organization (WHO) recommends that children and adolescents should accumulate at least 60 minutes of moderate-to-vigorous-intensity physical activity (MVPA) daily. Africa is rapidly undergoing an unprecedented phase of urbanisation and how to ensure healthy lives for its residents is increasingly becoming an important question. Some of the immediate effects of urbanisation are pressures on existing built environment. Previous reviews have synthesised associations between the built environments and physical activity in children and adolescents, but they have focused on non-African settings. Therefore, the first objective of this PhD study was to present evidence on the built environment constructs that were associated with physical activity among children and adolescents in Africa. Lagos occupies a unique position in West Africa subregion, as the city with the highest rate of urbanisation. As with most cities that are going through urbanisation, inequitable distribution of resources in different areas of the city affect physical activity. The second objective was to determine the proportion of school attending adolescents that reached the recommended MVPA level in Lagos State, Nigeria and to identify the predictors that were associated with reaching the recommended level. And finally, the third objective was to explore the barriers and facilitators of physical activity among school attending adolescents in Lagos State, Nigeria. Methods To achieve the above-mentioned objectives, three inter-related studies were conducted. First, a systematic review, adhering to the JBI methodology, was conducted to synthesise the existing evidence on the association of built environment constructs with physical activity among children and adolescents in Africa. Comprehensive electronic searches of ten databases from inception to 22 October 2021 were conducted to identify relevant published and unpublished studies. Two reviewers independently screened the papers, assessed the quality of the included studies using the JBI standard critical appraisal tool, and extracted data using a pre-piloted form. Where possible, data were synthesised using random effects meta-analyses, with effect sizes reported as mean differences (MD) with 95% confidence intervals (CI). The Grading of Recommendations Assessment, Development and Evaluations (GRADE) was used to assess the certainty of the findings. Second, a cross-sectional study was conducted among a representative sample of 720 adolescents aged 12-19 years from 20 schools in Lagos State, Nigeria in 2020. A validated physical activity questionnaire (Activity Questionnaire for Adults and Adolescents, AQUAA) was administered to assess MVPA and the predictors assessed were socio-demographic variables, anthropometric measurements, sedentary behaviour, self-efficacy, perceived benefits, and perceived barriers. Third, a qualitative study, using semi-structured interviews, was conducted to explore the views and experiences of 21 decision-makers, who were responsible for planning the physical and health education curriculum in secondary schools in Lagos State, Nigeria, on the barriers and facilitators of physical activity in school attending adolescents. Results In the systematic review, of the 10,706 identified records, six cross-sectional studies were included which comprised 4628 children and adolescents. Three of the studies had a high-quality score of 7 out of 8. Seven built environment constructs were reported within the included studies namely, residential density, street connectivity, crime safety, availability of physical activity facilities and infrastructure, walkability, aesthetics, and traffic safety. Three of the constructs were assessed with objective measures. Results from individual studies found significant associations between physical activity and objective measure of traffic safety (Mean difference (MD) 2.63 minutes; 95% Confidence interval (CI) 0.16 to 5.1; one study) and an objective measure of crime safety (MD 2.72 minutes; 95% CI 0.07 to 5.37; one study). No significant associations were found between active transportation and any of the built environment constructs. The GRADE evidence for all the assessed constructs was either low (the built environment constructs may lead to little or no difference in physical activity or active transportation) or very low (it was uncertain whether the built environment constructs affect physical activity). In the cross-sectional study, complete data was provided by 528 adolescents for the study (73% response rate). The recommended MVPA level was reached by 82.8% (95% CI 79.3–85.7) of the participants. Participants spent a median time of 44 (Inter quartile range (IQR) 12.9, 110) minutes of MVPA per day on household-based activities, followed by school-based activities (median 21.4; IQR 4.3, 50.4), active transportation (median 14.3; IQR 0, 35), sport-based activities (median 8.6; IQR 0, 58.9) and leisure-based activities (median 8.6; IQR 1.1, 34.3). Participants in public schools were four times more likely to meet the recommended MVPA level compared to those in private schools (Odds ratio (OR) 3.97, 95% CI 2.46–6.42). In the qualitative study, eight themes were identified and explored. The barriers to physical activity were (i)students’ characteristics (ii) parental objections (iii) no prioritisation of physical activity (iv) insufficient resources and (v) challenges with schools’ initiatives. The facilitators to physical activity were (vi) students’ interests (vii) students’ awareness of benefits and (viii) schools’ initiatives. Conclusion The evidence base for the association between built environment constructs and physical activity in African settings is limited, with no consistent evidence of an association. Therefore, further high-quality studies should be conducted before firm conclusions can be drawn. Findings from the cross-sectional study suggest that a high proportion of school adolescents met the recommended MVPA level in Lagos State, Nigeria. Additionally, our study suggests that interventions for promoting MVPA should be targeted to private schools. Our study’s finding from the qualitative study can help design interventions to increase physical activity among school attending adolescents in Lagos State, Nigeria

Physical Functionality and Self-Rated Health Status of Adult Patients with Knee Osteoarthritis Presenting in a Primary Care Clinic

Background: Knee osteoarthritis is a chronic medical condition of public health importance in Nigeria which causes disability and impacts daily activities in the sufferers. This study aimed to describe the physical functionality and self-rated health status of adult patients with clinical knee osteoarthritis presenting at the Family Medicine Department, University College Hospital, Ibadan, Nigeria.Method: This was a cross-sectional study of 400 respondents. Knee osteoarthritis was diagnosed clinically using the criteria of the American College of Rheumatology. Morbidities, self-rated health status and physical functionality of the respondents were also assessed.Results: Knee osteoarthritis was diagnosed in 46(11.5%) respondents. Respondents with knee osteoarthritis significantly rated their health worse than those without knee osteoarthritis (p &lt;0.0001). Experience of pain, stiffness and performance of daily activities were significantly worse among respondents with knee osteoarthritis. Those who had knee osteoarthritis had significantly higher waist (p &lt;0.0001), hip (p &lt;0.0001) and knee circumferences (p &lt;0.0001) respectively. Logistic regression analysis showed increasing age (OR=1.103; 95% CI=1.022 – 1.191), self-rated health worse than six months ago (OR=12.562; 95% CI=1.178–125.243), experience of stiffness after waking up in the morning (OR=12.758; 95% CI=3.572–45.569), stiffness after sitting/lying down/resting (OR=21.517; 95% CI=2.213–209.220) and waist circumference (OR=1.225;95% CI=1.017–1.477) to be the most significantly associated with knee osteoarthritis.Conclusion: Knee osteoarthritis significantly impairs the health and daily activities of adult patients in Ibadan, Nigeria. Healthcare workers need to screen adult patients routinely at first-contact to detect knee osteoarthritis clinically early and manage appropriately.Keywords: Family practice clinic, functionality, health status, knee osteoarthritis, Nigeri

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

Introduction:&nbsp;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:&nbsp;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:&nbsp;the high prevalence of snoring among elderly patients in Nigeria calls for concerted effort by healthcare workers to educate the elderly