Training of Doctors at the Geriatric Centre, University College Hospital, Ibadan, Nigeria

BACKGROUND

The population of older people is increasing exponentially and geriatric care is just evolving in Nigeria. There is a shortage of training opportunities for doctors in Nigeria to care for older people.

METHODS

This was an account of the conceptualisation, structure, and outcomes of the annual two-week basic certificate course in geriatric medicine for doctors at the University College Hospital (UCH), Ibadan, Nigeria, between 2016 and 2022.

RESULTS

In all, 204 doctors were trained. Their mean age was 40.1 ± 8.5 years, and 105 (51.5%) were females. Majority (80%) worked in public hospitals, especially in the tertiary health sector (62.2%). Annual participation increased from 26 participants in 2016 to 39 participants in 2022. Knowledge acquisition was the main reason for attending the course (56.7%). There were 42 didactic lectures and ten clinical/practical sessions. On average, participants' self-rating in caring for older persons improved significantly after (80.2 ± 12.7%) than before (49.9 ± 16.4%) the course [mean difference = 30.24%, 95%CI (25.91-34.57), p<0.0001]. Similarly, the overall post-course test score in the 20 MCQs (14.08 ± 2.89) was significantly higher than the pre-course test (12.51 ± 2.01) scores [Mean difference = 1.57, 95%CI (0.45-2.69), p = 0.007]. Some participants (37.8%) had commenced special clinics for older persons in 39 institutions across Nigeria.

CONCLUSION

Our training programme has yielded a modest increase in the capacity building of doctors for the care of older Nigerians. However, more concerted efforts are needed to train more doctors throughout Nigeria.

Relationship between family dynamics, spirituality, quality of life and happiness among older adults in Nigeria

Happiness of older adults in rarely studied in the global south like Nigeria compared with the global north. This study assessed the relationship between family dynamics, spirituality, quality of life and happiness among older adults in Nigeria. Cross-sectional study of 378 older adults (≥60 years) were selected. Oxford Happiness questionnaire, the family dynamics, spirituality, and quality of life (QoL) were determined with the Family Relationship Index, spiritual Index of Well-being scale and Quality-of-Life Brief questionnaire respectively. Descriptive and inferential statistics were carried out at α0,05. The mean age was 72,8±7,1 years and 255 (67,5%) were females. Majority 313 (82,8%) were assessed to be happy. Overall, family dynamics, spirituality, and health related QoL were significantly determinants of happiness (p<0,05). Among the women, there was good cohesion in the family dynamics (p=0,031), good health related QoL in the physical domain (p<0,001) and satisfaction with health (p=0,036) were the predictors of happiness. Having higher self-efficacy (p=0,018) and life scheme spirituality (p=0,050) were the predictors of happiness among the men. The present findings showed that most of the older adults were happy. Routine assessment and interventions could increase the feeling of happiness among older adults in the global south.

Integrative Care of the Older Persons in Nigeria: An Appraisal of the Geriatric Centre, University College Hospital, Ibadan

BACKGROUND

Geriatric medicine is an emerging subspecialty in Nigeria. The interest in the care of older Nigerians followed the Madrid International Plan of Action on Ageing in April 2002. This led to an increase in research, publications and advocacy culminating in the establishment of the pioneer geriatric centre in Nigeria in 2012. Since then, there has been an increase in capacity building, manpower development and institutionalization of geriatric care in Nigeria. This is an account of the evolution of the Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan (UCH).

METHODS

We undertook the review of the history, structure and key service elements in the Geriatric Centre, UCH from January 1, 2013, to December 31, 2020.

RESULTS

The number of patients rose from 2,559 in the first year to 19,300 by the end of 2020. The initial four multidisciplinary units increased to 12 over the review period. Likewise, the in-patient admission increased between the first year (122 patients) and 2020 (141 patients). The overall mortality rate was 11.4% over the review period. Internship opportunities were provided to students including resident doctors, undergraduates (medical) and postgraduate students (Masters and PhD). Besides, 139 medical doctors have undergone the annual basic certificate training in geriatric medicine organised by the Centre. Also, 7 fellowship dissertations and 11 peer-reviewed papers have been published.

CONCLUSION

The centre has demonstrated the possibility of caring for older patients in a low-resource setting. The employment of the multidisciplinary approach yielded a low mortality rate, higher attendance and manpower development.

Attitude towards ageing and perceived health status of community-dwelling older persons in a low resource setting: a rural-urban comparison

BACKGROUND

Older person's attitude to ageing is critical for their adjustment, acceptance of health-related behaviour, survival and choices. Their attitude influences how they cope with the challenges experienced while ageing, which affects their quality of life and health-related outcomes. Despite the increasing number of older persons in sub-Saharan Africa, there is limited information about their experience. This study examines the experience and attitude of older persons in Nigeria regarding the ageing process.

METHODS

A descriptive cross-sectional study among older persons aged 60 years and above was carried out in a selected rural and an urban community in Oyo State, south-western Nigeria. The study participants were selected using a multi-stage sampling technique. Trained research assistants collected data with the aid of an interviewer-administered, semi-structured questionnaire. The Attitude to Ageing Questionnaire (AAQ) was used to measure participants' perception of ageing in three domains (psychosocial loss, physical changes and psychological growth). Data were analysed using Stata version 14 at a level of significance p < 0.05.

RESULTS

A total of 1,180 participants (588 rural vs. 592 urban) were recruited for the study. The mean age was 73.2 ± 9.3 years. The majority (69.7 %) were females and still working (50.5 %). Overall, urban-dwelling participants had a better attitude to the ageing process in all the domains compared with rural-dwelling participants (psychological growth 32.5 ± 3.4 vs. 32.4 ± 3.3, p = 0.30; physical change 27.5 ± 5.1 vs. 26.9 ± 5.0, p = 0.03; and psychosocial loss 25.3 ± 5.7 vs. 25.0 ± 5.3, p = 0.60). Among the rural and urban-dwelling participants, good self-rated health was significantly associated with a positive attitude to ageing across the domains.

CONCLUSIONS

Older persons residing in urban communities had higher positivity to ageing than their rural older counterparts. The common factor significantly associated with a positive attitude to ageing in both groups was good self-rated health. This information can be used for the planning of targeted interventions and informing policy formation for improved provisions for community-dwelling older persons in Nigeria and other sub-Saharan African countries.

A descriptive study of the morbidity pattern of older persons presenting at a Geriatric Centre in Southwestern Nigeria

CONTEXT

Rapid population ageing is a demographic reality in most countries of the world. Old age is associated with changes which may culminate in health problems, necessitating provision of appropriate preventive, curative, and rehabilitative services. However, reports from many low- and middle-income countries have shown lack of preparedness to cater for the healthcare needs of older persons.

AIM

This study described the morbidity profile and its determinants among persons aged 60 years and above who presented at an established geriatric centre in southwestern Nigeria.

MATERIALS AND METHODS

Data were obtained from electronic health records of 4886 patients aged ≥60 years who visited the facility between 1st January 2013 and 31st December 2014. Data were analyzed using Stata version 13 (Texas, USA). Frequency distributions were used for descriptive analysis, and chi-square test was used to test associations.

RESULTS

More than a half, 2919 (59.7%), of the respondents were females and almost three quarters 3501 (71.7%) were aged between 60 and 74 years. Mean number of morbidities was 1.81 ± 0.9, and less than half, 1097 (42.0%), presented with only one morbidity, most commonly, hypertension. There were significant age-related differences for musculoskeletal (P = 0.001), endocrine (P = 0.01), and psychological problems (P = 0.01). In addition, gender differences were observed as a significantly higher proportion of females presented with general symptoms (P = 0.02) and musculoskeletal problems (P = 0.0001) than men.

CONCLUSION

The most common presenting morbidities at this geriatric health centre were mostly noncommunicable diseases. Information obtained will be useful in the design of similar facilities in other parts of the country and region at large.

Prevalence of previously undetected tuberculosis and underlying risk factors for transmission in a prison setting in Ibadan, south-western Nigeria

People with congregational tendencies such as the prison inmates constitute an important target group in the global efforts towards the control of tuberculosis (TB). The prison setting in most developing countries particularly Nigeria, currently does not have routine diagnostic procedures for TB despite the existing risks that could facilitate disease transmission. We conducted a cross sectional study among the inmates in a major prison in south-western Nigeria for TB by screening their sputum samples using a simple random sampling method coupled with questionnaire interview, on the assumption of sub-clinical pulmonary TB infection. The overall TB prevalence found was 1.2% (2/164). Significant risk factors that could facilitate disease transmission in the prison included lack of BCG immunization (p = 0.017); history of contact with TB patients (p = 0.020); prolonged cough (p = 0.016) and drug abuse (p = 0.019). Our findings of 1.2% undetected pulmonary TB infection among the inmates though low; still reiterate previous observation that the prison setting constitutes a veritable environment for TB transmission and a threat to public health. Efforts are therefore needed to institute routine screening and reduce the risk factors associated with TB transmission among prison inmates in Nigeria.

Knowledge about complications and practice of abortion among female undergraduates in the university of ibadan, Nigeria

Background:

Unwanted pregnancies and unsafe abortion pose major health risks to women in the reproductive age group. Female undergraduates are particularly exposed to these risks. This study was carried out to assess the knowledge about complications and practice of abortion among female undergraduates of the University of Ibadan.

Methods:

A cross-sectional study was conducted using structured, self-administered questionnaires, to collect data on respondents’ socio-demographic characteristics, sexual behaviour, knowledge about various complications of abortion and practice of abortion. Data was analyzed using SPSS version 14.

Results:

A total of 425 students were interviewed, mean age of the undergraduates was 21.5± 2.8 years. Overall, 122 (29%) of the respondents had ever had sexual intercourse. Twenty five percent of those who were sexually active had ever been pregnant and 90% had terminated the pregnancy. The most common reason given for termination was that pregnancy was unplanned for. Most of the respondents 354 (83.3%) had a good knowledge about complications of abortion and mean knowledge score was 4.01±1.58 (range 0-5).

Conclusion:

This group of students were aware of the risks associated with unsafe abortion; however, the abortion rate was still high. Sexual reproductive health interventions are needed on campus in order to equip female undergraduates with comprehensive knowledge and skills to reduce the likelihood of unplanned pregnancies