The global burden of hypertension and other non-communicable diseases (NCDs) is rapidly increasing, and the African continent seems to be the most affected region in the world. The prevalence of ...hypertension in Nigeria forms a substantial portion of the total burden in Africa because of the large population of the country currently estimated to be over 170 million.
The purpose of this systematic review is to summarise up to date data on the prevalence and distribution of hypertension in Nigeria from prevalence studies.
A search of the following databases: PubMed, EMBase and WHO cardiovascular InfoBase from 1968 till date was conducted to identify studies which provide estimates of prevalence of hypertension in Nigeria.
The search yielded a total of 1748 hits from which 45 relevant studies met the inclusion criteria for the review. The overall crude prevalence of hypertension ranged from 0.1% (95%CI:-0.1 to 0.3) to 17.5% (95% CI: 13.6 to 21.4) in children and 2.1% (95%CI: 1.4 to 2.8) to 47.2% (95%CI: 43.6 to 50.8) in adults depending on the benchmark used for diagnosis of hypertension, the setting in which the study was conducted, sex and ethnic group. The crude prevalence of hypertension ranged from 6.2% (95%CI: 4.0 to 8.4) to 48.9% (95%CI: 42.3 to 55.5) for men and 10% (95%CI: 8.1 to 12) to 47.3% (95%CI: 43 to 51.6%) for women. In most studies, prevalence of hypertension was higher in males than females. In addition, prevalence across urban and rural ranged from 9.5% (95%CI: 13.6 to 21.4) to 51.6% (95%CI: 49.8 to 53.4) and 4.8% (95%CI: 2.9 to 6.7) to 43% (95%CI: 42.1 to 43.9) respectively.
The prevalence of hypertension is high among the Nigerian population. Appropriate interventions need to be developed and implemented to reduce the preventable burden of hypertension especially at Primary Health Care Centres which is the first point of call for over 55% of the Nigerian population.
The aim of the study was to elicit beliefs about hypertension among Nigerian immigrants in the United Kingdom.
The distributions of cardiovascular risk factors and diseases are not shared equally ...across ethnic and economic groups in the United Kingdom. Its burden is more clustered among minority ethnic populations and migrant groups including black African Nigerian migrants. Similar patterns have been reported across Europe, Australia, Canada, Nordic countries and the United States of America. There are about 300 distinct ethnic groups in Nigeria and reliable information about their beliefs about hypertension is not available. Given that the United Kingdom has a large community of Nigerian immigrants from these different ethno-cultural backgrounds, understanding their unique beliefs about hypertension may help promote appropriate care for this population in the United Kingdom and Nigeria.
A single Pentecostal church community in West London.
Twenty-seven Nigerian migrant members of the church entered and completed the study.
A qualitative interview study was conducted. The interviews were analysed using thematic framework analysis. The outcome measures were emerging themes from the thematic framework analysis.
Participants expressed beliefs in four major areas related to hypertension: (1) The Meaning of the term hypertension, (2) Perceptions of causation, (3) Effects of hypertension, and (4) Perceptions of treatment. The study revealed a diversity of beliefs about hypertension which incorporated both orthodox and culturally framed ideas.
This study identified important beliefs among Nigerian migrants about hypertension that can contribute to our understanding of the management of hypertension in this group and suggests the need for further research to determine whether these beliefs may be representative of this group.
The main objective of the study was to elicit beliefs about hypertension among Nigerian Primary Health Care clients and workers.
In many regions of Nigeria, the primary health care facility is ...usually the only source of formal health care available. Since hypertension is a chronic condition that requires lifelong life style modification and drug treatment, it is important to understand the context and background to the condition through the beliefs and perceptions among both lay persons and health care providers who manage the condition.
Rural and urban primary health care facilities in the Federal Capital Territory Nigeria.
A total of Eighty-one (81) primary health care clients and workers participated in the study.
A qualitative research using interviews, focus group discussions and reflective work as sources of data collection. The outcome measures were emerging themes from thematic framework analysis.
There were four themes that summarize beliefs of both PHC workers and clients namely: (1) Meaning of hypertension (2) causes of hypertension, (3) Consequences of hypertension (4) Perceptions of treatment, one additional distinct theme was elicited among PHC workers "contextual explanation". However, under each of the shared four themes, there were both similarities and differences in beliefs expressed between PHC workers and clients.
This study highlights important similarities and differences in beliefs about hypertension among primary health care clients and primary health care workers that have significant implications for management of hypertension in primary care settings in Nigeria.
Hypertension is a major health risk factor for mortality globally, resulting in about 13% of deaths worldwide. In Nigeria, the high burden of hypertension remains an issue for urgent attention. The ...control of hypertension, among other factors, is strongly determined by personal beliefs about the illness and recommended treatment.
The aim of this review is to systematically synthesize available data from all types of studies on beliefs of the Nigerian populace about hypertension.
We searched the following electronic databases; Medline, EMBase, PsycInfo, AMED from their inception till date for all relevant articles. A modified Kleinman's explanatory model for hypertension was used as a framework for extraction of data on beliefs about hypertension.
The search yielded a total of 3,794 hits from which 16 relevant studies (2 qualitative, 11 quantitative and 3 mixed methods studies) met the inclusion criteria for the review. Overall, most health care providers (HCPs) believe that stress is a major cause of hypertension. Furthermore, reported cut-off point for uncomplicated hypertension differed widely among HCPs. Lay Health Care Providers such as Patent Medicine Vendors' beliefs about hypertension seem to be relatively similar to health care professionals in areas of risk factors for hypertension, course of hypertension and methods of treatment. Among Lay persons, misconception about hypertension was quite high. Although some Nigerians believed that life style habits such as alcohol intake, exercise levels, cigarette smoking were risk factors for developing hypertension, there was discordance between belief and practice of control of risk factors. However, beliefs across numerous ethnic groups and settings (urban/rural) in Nigeria have not been explored.
In order to achieve control of hypertension in Nigeria, interventions should be informed, among other factors, by adequate knowledge of beliefs regarding hypertension across the numerous ethnic groups in Nigeria, settings (rural/urban), age and sex.
ObjectiveTo explore the views of senior doctors on mental illness within the medical profession.BackgroundThere has been increasing interest on the issue of doctors’ mental health. However, there ...have been few qualitative studies on senior doctors’ general attitude towards mental illness within the medical profession.SettingLarge North London teaching hospital.Participants13 hospital consultants and senior academic general practitioners.MethodsA qualitative study involving semi-structured interviews and reflective work. The outcome measures were the themes derived from the thematic framework approach to analysis.ResultsFour main themes were identified. (1) ‘Doctors’ attitudes to mental illness’—doctors felt that there remained a significant stigma attached to suffering from a mental illness within the profession. (2) ‘Barriers to seeking help’—doctors felt that there were numerous barriers to seeking help such as negative career implications, being perceived as weak, denial and fear of prejudice. (3) ‘Support’—doctors felt that the use of support depended on certainty concerning confidentiality, which for occupational health was not thought to be guaranteed. Confiding in colleagues was rare except among close friends. Supervision for all doctors was raised. (4) ‘General Medical Council (GMC) involvement’—doctors felt that uneasy referring colleagues to the GMC and the appraisal and revalidation process was thought not to be thorough enough in picking up doctors with a mental illness.ConclusionsOwing to the small size of this study, the conclusions are limited; however, if the findings are confirmed by larger studies, they suggest that greater efforts are needed to destigmatise mental illness in the profession and improve support for doctors. Additional research should be carried out into doctors’ views on occupational health services in managing doctors with mental illness, the provision of supervision for all doctors and the effectiveness of the current appraisal and revalidation process at identifying doctors with a mental illness.
ObjectiveTo explore the views and attitudes of Indians living in England on blood donation.BackgroundIn light of the predicted shortages in blood supply, it is vital to consider ways in which to ...maximise donation rates. These include addressing the issue of lower donation rates among ethnic minorities, including Indians. However research specifically among minority ethnicities in UK is sparse.SettingGeneral practice in North London.ParticipantsA convenience sample of 12 non-donor Indians living in England.MethodsThis is a qualitative investigation involving semistructured interviews. Themes derived were analysed using thematic framework analysis.ResultsFive key themes emerged from the data, and these concerned participants’ perspectives regarding attitudes towards blood, blood donation as a ‘good thing’, donation disincentives, the recipient matters and the donor matters.ConclusionA variety of attitudes were presented, but were generally positive, and blood was conceptualised in a manner previously found to be consistent with donation. However, lack of awareness and accessibility were prominent barriers, indicating the need for improvement in these capacities. In contrast to this, blood was also greatly associated with family and acted as a symbol of kinship: this ‘emotional charge’ often acted to dissuade participants from separating with their blood through donation. Possibly due to this, there was also a strong preference for donated blood to be distributed within the family, as opposed to strangers. This presents a potential barrier to blood donation for some Indians within the current system in which donations are given to unknown recipients.
ObjectiveTo explore medical students’ views on and experiences of responding to out-of-hospital medical emergencies.SettingUniversity College London (UCL).Participants11 UCL Medical School ...students.Study designQualitative.Methods and outcome measuresWe carried out 11 one-to-one semistructured interviews, with participant validation and reflective work. The data were analysed using thematic analysis.ResultsThree core themes were identified. (1) ‘We Did Debate a Bit: Should We Go? Should We Not?’—Students’ decisions to respond were based on the appearance of the casualty; the presence and actions of bystanders; witnessing the incident; self-perceived competence, confidence and knowledge; and personal experiences and feelings associated with medical emergencies. (2) ‘It Would Represent the Medical Profession Well if We Did Step In and Help’—Students felt that they had an ethical and/or professional duty to help. (3) ‘No One Should Die Because of a Lack of… Basic Life-Saving Techniques’—Students felt that medical school training alone had not sufficiently prepared them to respond to out-of-hospital medical emergencies. Improvements to training were suggested: integrating first aid/response training into the horizontal (systems-based) modules; teaching both common and less common medical emergencies and presentations; training that is led by experienced first responders and that increases students’ exposure to out-of-hospital medical emergencies; and providing more revision training sessions.ConclusionsStudents felt that medical school training could be improved to better prepare them for responding to out-of-hospital medical emergencies, and wanted clarification on whether or not they have an ethical and/or professional duty to help. Further mixed-methods research using a larger sample needs to be carried out to confirm whether findings are transferable to other UK medical schools.
Background. The 29-item ‘Medical Interview Satisfaction Scale’ (MISS-29) was developed in the USA to assess patient satisfaction with individual doctor–patient consultations. It has been used in ...studies from British general practice. However, there is limited evidence for its psychometric properties in this population. Objectives. The present study was designed to examine the validity, reliability and applicability of the MISS-29 in British general practice populations. Methods. The study was divided into two phases. The first investigated the properties of the MISS-29 in a UK general practice population and resulted in a modified MISS (MISS-21). The second investigated the properties of the MISS-21 in a wider UK general practice population. In phase 1, 150 patients over 16 years were recruited sequentially from patients attending a large group practice in suburban north London. Patients completed a questionnaire which collected demographic data and the MISS-29. In phase 2, 159 patients with a new problem were recruited from patients over 16 years consulting 18 GPs in north London, Essex and Suffolk. Patients completed a questionnaire while waiting to see the doctor; this collected demographic data and included six separate items, designed by the author, intended to measure patient satisfaction with previous consultations with the doctor. The patients completed the MISS-21 when they left the doctor's consulting room. Results. The response rates for the phase 1 and phase 2 studies were 76.9 and 72.6%, respectively. Factor analysis, using principal component analysis with a varimax rotation, of the data collected in phase 1 resulted in a 21-item scale with the same four subscales as the original MISS-29. Correlations between subscales range from 0.46 to 0.65. Values of Cronbach's alpha between 0.67 and 0.92 suggest that the subscales are internally consistent under the conditions of the study. In phase 2, 92.1% completed all the items in the MISS-21 and there were no significant relationships between patients' demographic variables and the proportion of completed MISS-21 questionnaires, nor were there any differences in the proportion of completed MISS-21 questionnaires between type of practice or between practices serving different geographic populations, suggesting that the items were acceptable to patients. There were highly significant positive correlations (0.21–0.63) between scores on the MISS-21 and all aspects of satisfaction with previous consultations, providing supportive evidence for the construct validity of the MISS-21. Conclusion. This study has demonstrated that the use in British general practice of the 29-item MISS developed in the USA should be treated with caution. However, a new 21-item version with the same four subscales as the 29-item MISS was developed which has satisfactory internal reliability. The correlations between subscales suggest that they represent fairly discrete but overlapping aspects of satisfaction. Evidence is produced suggesting that patients have less difficulty completing the MISS-21 and that it is applicable for assessing satisfaction with the consultation in different practice types and populations in the UK. Limited data supporting the construct validity of the MISS-21 are presented. While this study does not provide a full assessment of the MISS-21, we believe it provides evidence for its psychometric properties, which suggests that it is a valid and reliable instrument for the assessment of patient satisfaction with individual consultations in British general practice.
Background Doctors have high levels of self‐treatment, investigation and referral, but little is known about how medical students seek health care.
Methods We carried out a questionnaire survey of ...Year 2 and 4 students, exploring their health‐seeking behaviour and attitudes to self‐care.
Setting A London medical school.
Results The response rate was 80%. Nearly all students (99%) were registered with a general practitioner (GP). A total of 43% had informally consulted doctors who were friends or relatives in the previous 12 months (61% of those with a doctor as a family member had informally consulted, and 33% of those without a doctor as a family member had informally consulted; P = 0.001). In all, 13% of Year 4 students and 2.2% of Year 2 students had received a prescription from a friend (P = 0.007). Almost a quarter (22%) of Year 4 and 1.3% of Year 2 students reported having directly contacted a specialist (P = 0.01). A third (32%) (43% Year 4, 1.3% Year 2; P = 0.006) of those referred in the previous 12 months had contacted the consultant directly. In all, 9.2% (0% Year 2, 20% Year 4; P = 0.001) had initiated their own investigations, and 25% (47% Year 4, 7% Year 2; P = 0.001) had been examined by a colleague. Students agreed that it was appropriate for doctors to self‐investigate (52%), self‐refer (59.1%) and self‐prescribe (39.2%).
Conclusion Medical students appear to bypass their GPs and initiate investigations, referrals or treatment. This is associated with increased clinical access or access through family members. Self‐management of illness is learnt early on in students' careers and is increased with availability and increasing clinical access.
This paper describes a BSc in Primary Health Care. The course is in its fourth year, with seventeen graduates. We expect the nine currently enrolled to graduate in summer 2001. The aims of the course ...are to give students additional skills, that are generic to medicine (research methods etc.) and also specific to primary health care. The course consists of a taught component about the theoretical background to primary care, with input from the social sciences, epidemiology and public health. The self-directed component consists of a research project and, unusually for a BSc, a regular clinical placement. This course may help to change students' expectations that BScs are only for those who are interested in laboratory based medicine.
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