Papers by Ndifreke UDONWA
ABSTRACT Family Medicine (General Medical Practice) established as a medical specialty with the s... more ABSTRACT Family Medicine (General Medical Practice) established as a medical specialty with the special role of evaluating the total health needs of individuals and families irrespective of age, sex, disease or stage of illness in the context of their unique environment was one of the specialties included for training in a 14-faculty Postgraduate Medical College in Nigeria in 1970. The inclusion was informed by the need to train physicians who will adapt their knowledge, competence and skills to the unique and challenging environment of a developing country like Nigeria. The peculiar, broader health needs of Nigeria and the rather few specialists in other fields required a realistic conceptual framework. Through the active collaboration of the Association of General Medical Practitioners of Nigeria (AGMPN) and the Postgraduate Medical College of Nigeria (PMNC) a vocational training syllabus, with international inputs, was developed for the training. This paper reviews the beginning, progress and milestones within the last ten decades (1980 – 2010) of the specialty in Nigeria and makes suggestions on how to overcome the challenges encountered within the period in order to chart a less challenging road map for training, services and research in Family Medicine. In particular organising specialist clinics for family medicine; defining sub-specialties in family medicine, research focus in family and family-related issues, collaboration with other specialties, and lack of undergraduate training in all universities as the primordial stem in which the specialist courses would derive legitimacy seem to be the key issues that have to be addressed in the next phase of development of the specialty in Nigeria.
South African Family Practice, Aug 28, 2015
Hypertensive patients' expectations are a major determinant of treatment outcomes. This study was... more Hypertensive patients' expectations are a major determinant of treatment outcomes. This study was undertaken to determine the pattern of expectations of hypertensive patients as a basis for modification of the care given to them. Methodology: This was a descriptive hospital study involving 260 hypertensive patients aged above 20 years, randomly selected. Study participants were engaged in patient-centred consultation during each visit. Their socio-demographic characteristics were collected using a semi-structured questionnaire, while the expectations of the hypertensive patients were also assessed. Their blood pressure was measured on three (3) occasions at two-monthly intervals. Data were analysed using SPSS version 20.0 and data were presented in tables. Results: The majority of the respondents (161, 61.9%) were females while the males numbered 99 (38.1%). Most (219) of the respondents were older than 40 years and had some form of education. The majority of the respondents needed information on hypertension (85.3%), expected that the hypertensive medication they would be given wouldlower their blood pressure (88.5%), and expected a cure of their hypertension (70.4%). There were some respondents who did not have any expectations. Conclusion: Hypertensive patients have varying illness expectations that can be explored using the patient-centred consultation strategy to improve treatment outcomes.
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria, Jan 14, 2008
The issue of human capital flight has been discussed at different forums with a consensus opinion... more The issue of human capital flight has been discussed at different forums with a consensus opinion that it has its merits and demerits to equitable health system. Most often one nation becomes a substantial net exporter of talent, leaving the provider nation at risk of depleting its natural supply of talent. This paper looks into the historical perspective of human capital flight or "brain drain", and its burden. It attempts to elucidate the various causes and suggested solutions. The paper's objective is to educate colleagues on the conceptual and contextual imperatives of the issue. Using a convenient sample of key informants who were medical colleagues in Nigeria relevant information was sourced from these colleagues, documents from the postgraduate medical college of Nigeria and the internet on maters relating to human capital flight and brain drain. Every year, thousands of qualified doctors, and other professionals leave Nigeria tempted by significantly higher wages, brighter prospects for employment and education, stability, food security. It appears that the potential exposure to different working conditions, resources and professional environments can be of advantage to the country, should Nigeria be able to recall these professionals. It also appears that necessary economic reforms that make staying at home rewarding, that is--good leadership, and policy planning that seriously looks into rural development, among other issues, are keys ingredients to reversing the trend in order to ensure a more equitable health system.
The Nigerian medical practitioner, May 17, 2004
ABSTRACT The faculty of General Medical Practice has change its name to the faculty of Family Med... more ABSTRACT The faculty of General Medical Practice has change its name to the faculty of Family Medicine The change has come partly due to world wide response to the call by the World organization of family doctors calling on all colleges, academies, societies and associations of general practitioners that have a postgraduate/specialty program to change and due to pressure from societal view of the certified members not being regarded as a specialist. Also the public view of not being able to differentiate those with basic medical degree and those who have acquired specialist qualification from the general practitioners has prompted this paper. Using a convenient sample of key informants who were faculty officers in the National postgraduate medical college of Nigeria and the West African college of physicians faculty of General medical practice /family practice who sourced information from documents and the internet this paper explores the extent to which Family Doctors are being trained to be relevant in the West African subregion. The principles, attributes and skills for family practice in a developing economy as ours is highlighted. It is the breath of care of family practice with a depth of competencies that makes the difference from general medical practiceNig. Medical Practitioner Vol. 45(1/2) 2004: 9-13
Nigerian Journal of Clinical Practice, Mar 1, 2008
Objective: To determine the involvement of medical practitioners working in a tropical setting in... more Objective: To determine the involvement of medical practitioners working in a tropical setting in the treatment of their relatives. Design: Cross-sectional. Subjects: Medical practitioners of all cadres working in the University of Calabar Teaching Hospital, Calabar, Nigeria. Setting: A large teaching hospital in Calabar, Nigeria. A referral centre for two states. Main outcome measures: Extent, type and effect of involvement in the practice. Results: Majority (90.9%) of medical practitioners in our centre were found to have been involved in the treatment of their relatives. Services rendered included consultation, in which all respondents (100%) have partaken. Cardiopulmonary resuscitation (16.9%) and emergency surgery were performed by only a few (3.1%). Though fees were not charged for services provided by most; a few (13.1%) did so. Outcome of involvement was unfavourable in some instances: 9.4% lost relatives they were involved in treating. Majority of the respondents 51.7% believed it is unethical to treat relatives and advocated for only limited involvement. This is because the pressure from relatives for care cannot be entirely ignored. Conclusion: It is difficult in our environment not to accede to request to treat family members. We recommend that practitioners may offer only consultation, and in some cases treat minor ailments while referring more serious ones to appropriate colleagues.
Mary Slessor Journal of Medicine, 2006
Asian Journal of Medicine and Health, 2019
Background: Despite the fact that anaemia is a preventable morbidity in most cases, its prevalenc... more Background: Despite the fact that anaemia is a preventable morbidity in most cases, its prevalence among pregnant women is still unacceptably high especially in rural and sub-urban settings. This is worrisome considering the enormous contribution of anaemia to maternal and infant morbidity and mortality. Objective: This study aimed at determining the prevalence of anaemia at booking, identifying and describing its risk factors among pregnant women who attended the antenatal clinic of General Hospital, Etinan, a sub-urban area in Akwa Ibom State, South-South Nigeria. Methodology: This was a cross-sectional descriptive study involving 375 pregnant women seen at the antenatal (booking) clinic of General Hospital, Etinan, between April and October 2018, recruited through non-probability consecutive sampling technique. A pretested semi-structured interviewer-administered questionnaire was used to obtain data on socio-demographic, family and nutritional characteristics and obstetric and ...
International Journal of Medical Science, 2019
Nigerian Journal of Family Practice, Feb 7, 2018
Background: Patient satisfaction is an important indicator of quality of care. Satisfied patients... more Background: Patient satisfaction is an important indicator of quality of care. Satisfied patients have been shown to be more likely to adhere to treatment plans and guidelines. They also exhibit better care seeking behaviour and this leads to a reduction in mortality. Methods: This was a cross sectional study carried out at the NHIS clinic of UUTH between August and October 2014. A total of 418 eligible respondents were recruited using a systematic random sampling technique and a semi-structured self-administered questionnaire was used to collect information from respondents. Results: The mean age of respondents was 41.6 ± 9.1 years. The overall level of satisfaction with services rendered was 80.6%. Statistically significant factors positively affecting patient satisfaction were duration of consultation (χ 2 = 26.41, p < 0.001), consultation process (χ 2 = 24.03, p < 0.001), attitude of the doctor (χ 2 = 44.10, p < 0.001), access to specialists (χ 2 = 29.39, p < 0.001), ease of registration (χ 2 = 15.46, p < 0.001), quality of service of clerical staff (χ 2 = 46.12, p < 0.001), quality of service at the pharmacy (χ 2 = 51.00, p < 0.001), quality of service at the NHIS administrative office (χ 2 = 166.00, p < 0.001), ease of payment (χ 2 = 37.13, p < 0.001), waiting time (χ 2 = 41.50, p < 0.001), comfort in the waiting room (χ 2 = 31.10, p < 0.001), quality of service of hospital staff (χ 2 = 106.60, p < 0.001), and quality of service of nursing staff (χ 2 = 63.87, p < 0.001). However, patient-related factors were not statistically significant in influencing overall satisfaction. Conclusion: Overall satisfaction rate was satisfactory. Client satisfaction was positively influenced by physician-related factors and system-related factors but was uninfluenced by patient related factors. Efforts must be made by healthcare providers to improve all aspects of the patient experience so as to improve enrolment and health services utilization. Keywords: Patient satisfaction, health insurance, NHIS, Uyo, Family Medicine
West African journal of medicine, 2020
BACKGROUND Hypertension is a modifiable risk factor for cardiovascular, cerebrovascular and renal... more BACKGROUND Hypertension is a modifiable risk factor for cardiovascular, cerebrovascular and renal diseases. OBJECTIVE The objective of the study was to determine the risk factors for Hypertension among adults attending the general outpatient clinic of University of Uyo Teaching Hospital. METHODS A cross-sectional study of three hundred and eightyfive (385) adults (18 years and above) attending the General Outpatient Clinic of the University of Uyo Teaching Hospital, Uyo, Nigeria, was carried out between March and June, 2013. Information on socio-demographic characteristics, presence or absence of hypertension, symptom counts, duration of illness as well as risk factors for hypertension were sought. RESULTS The study 385 subjects consisted of 166 males and 219 females (male: female = 1:1.3). The mean age of respondents was 37.7± 14.4 years. After multivariate analysis, age, family history of hypertension and obesity were identified as independent risk factors for hypertension in this...
Nursing and health, Mar 1, 2017
The study aimed at determining the hypertensive patients' illness experience, using the patient-c... more The study aimed at determining the hypertensive patients' illness experience, using the patient-centred consultation approach in order to form a better partnership with the patients. Design: This was a cross-sectional hospital-based study using a semi-structured questionnaire that assessed the socio-demographic characteristics of the respondents. The respondents' fears about hypertension, ideas about its cause and expectations from consultation were explored. The response was based on a Likert scale. The data were analysed with the SPSS software version 15. Settings: This study was conducted at the GOPC, UCTH Calabar. The GOPC is the "window" of the Hospital. Subjects/participants: Two hundred and sixty eight hypertensive patients were recruited into the study. Results and Conclusions: The respondents expressed fear regarding most aspect of hypertension. Most (74.7%) agreed that hypertension could be caused by stress. A few participants gave non-biomedical views of the aetiology of hypertension, including attributing it to spiritual forces. Over three quarters of respondents (85.1%), expected their medications to give them corrective measures to hypertension. The study supports the fact that hypertensive patients have varying illness experiences that should be explored using the patient-centred consultation style and recommends that doctors should manage individual patients to suit the patients' unique experience. There was an established significant relationship between expectation and fears/ideas.
Global Journal of Pure and Applied Sciences, Nov 30, 2017
Background: The burden of HIV/AIDS has reduced following sustained interventions especially with ... more Background: The burden of HIV/AIDS has reduced following sustained interventions especially with introduction of highly active antiretroviral therapy (HAART). HIV/AIDS has become a chronic condition for which adherence to therapy is of public health relevance. This study was aimed at assessing the relationship between adherence to HAART and clinical and laboratory outcomes in a tertiary centre. Methodology: This was a cross-sectional descriptive study of three hundred and forty eight (348) respondents on HAART. Adherence was measured using an adapted adult AIDS clinical trial group (AACTG) with optimal adherence set at ≥95%. Clinical stage, anthropometry, CD4, total lymphocyte and haemoglobin were used to monitor clinical, immunological and haematological outcome of adherence. Result: The mean (SD) age of respondents was 34.8 (5.3) years, ranging from 18-68 years, with male: female ratio of 1:1.7. Adherence to HAART was 89.1%. Non-adherent compared with adherent respondents, had marginally significantly higher proportion of WHO AIDS Stage 3 disease (44.7% vs. 26.4%, p=0.05). Comparing baseline with current values, change in mean CD4 cell counts was significantly higher among adherent compared with non-adherent respondents (187 vs. 125, p=0.00). Also, change in mean total lymphocyte counts was significantly higher among adherent compared with non-adherent respondents (508 vs. 314, p=0.00). Change in CD4 cell count significantly correlated with adherence (t=0.15, p<0.05). Conclusion: Self-reported optimal adherence significantly correlated with immunological recovery, which is a key determinant of good clinical outcome in HIV patients. Measures aimed at sustaining adherence to HAART, and regular assessment of CD4 count should be strengthened.
Asian Pacific Journal of Tropical Medicine, Apr 1, 2010
Open Access Macedonian Journal of Medical Sciences, Sep 8, 2022
BACKGROUND: Due to the novel nature of COVID-19, management strategies are poorly understood by m... more BACKGROUND: Due to the novel nature of COVID-19, management strategies are poorly understood by most primary care providers (PCPs), especially in the low-and middle-income countries (LMICs) of the world. If the knowledge of PCPs concerning COVID-19 is enhanced, awareness, perception, and attitude toward patient care will improve. Consequently, maximum prevention and control will be achieved. AIM: This study aims at assessing the awareness, knowledge, and willingness of the PCPs to care for COVID-19 patients in Calabar, Nigeria. METHODS: A cross-sectional descriptive study was used to evaluate 1126 PCPs (doctors, nurses, and community health officers) actively working in government primary, secondary, and tertiary health-care facilities in Calabar, Nigeria. A total population sampling method was employed and a validated, semi-structured, 33-item questionnaire was used to explore the objectives of the study. RESULTS: Majority (99.4%) of the study participants were aware of COVID-19. Most (68.4%) information regarding COVID-19 came from the social media. Bonferroni post hoc test of multiple comparisons revealed that the knowledge score for PCPs in tertiary (11.2 ± 8) was significantly higher compared to those in secondary (10.6 ± 1.6) and primary levels of care (10.7 ± 1.7). Approximately 55.3% of the participants did not want to be involved in the management of COVID-19 patients. CONCLUSION: There is the need to focus and intensify training of the PCPs working at the primary and secondary levels of care to increase their awareness, knowledge base, willingness to care for patients and eventually reduce morbidity and mortality associated with COVID-19 in the study setting.
Family Medicine and Medical Science Research, 2016
Background: Non-specific low back pain is a common health problem incurring immense health and so... more Background: Non-specific low back pain is a common health problem incurring immense health and social costs with concomitant disability, which has assumed significant public health importance in our setting. The impact from this condition is multi-factorial, and includes pain, activity limitations and impairment of quality of life. This study therefore aimed to examine the level of low back pain disability, its correlates and predictors, and the impact on selfperceived quality of life. It also sought to determine the predictors of health-related quality of life among low back pain patients in a Family Practice setting in Calabar, Nigeria. Method: This was a cross-sectional analytical study involving 350 consecutively selected patients with nonspecific low back pain. Standardized questionnaires were used including: the Oswestry Disability Index (ODI) questionnaire, the 12-item General Health Questionnaire (GHQ-12), the Short-form 36 (SF-36) questionnaire and the Visual Analogue Pain Scale. These were used to assess low back pain disability, psychological distress, healthrelated quality of life and pain intensity respectively. Result: The mean age of the respondents was 36.16 ± 9.93 years. Majority (70.6%) were females and had chronic pain lasting more than three months. Most of the respondents (88.9%) characterized their pain as severe. The mean health-related quality of life score was 45.82 ± 4.3. Factors associated with severe disability were: psychological distress and pain intensity. Significant correlations were observed between disability, pain intensity and psychological distress using Pearson's correlation analysis. Independent risk factors for disability were psychological distress and those with chronic pain lasting more than 3 months. Overweight and obese subjects were more likely to have poor health-related quality of life when compared with those with normal body mass index (X 2 =8.81, P<0.05). The significant predictors of poor health-related quality of life using logistic regression were overweight/obesity and those with severe disability. Conclusion: This study identified significant correlations between low back pain disability, pain intensity and psychological distress. These correlations could be informative and should guide family physicians in the management of the index problem in our environment. The perception of quality of life in individuals with low back pain should also raise awareness of issues connected to the problem and encourage more research into this area.
African Journal of Primary Health Care & Family Medicine, Mar 4, 2010
Background: Malaria prevention and treatment constitute an unbearable economic burden to most Afr... more Background: Malaria prevention and treatment constitute an unbearable economic burden to most African countries, especially south of the Sahara, where about 500 million cases occur annually. The problem of malaria among adolescents has largely been overshadowed by the huge burden of the disease among young children. Attention to malaria among adolescents has also been diverted by the huge burden of HIV/AIDS among adolescents. Some surveys reveal a lack of knowledge and many misconceptions about the transmission and treatment of malaria, which could adversely affect malaria control measures and antimalarial therapy. Such a knowledge gap could have an adverse effect on school children, who could be used as change agents and as role models for their siblings and peers in the malaria control strategy. Objectives: To determine the malaria prevention practices of school adolescents in the coastal community of Calabar, Nigeria. Method: This was a cross-sectional survey involving secondary schools in southern Calabar. Four hundred adolescents were randomly selected from the 4565 learners in 5 out of 17 secondary schools in southern Calabar, Cross River State, Nigeria. A self-administered, semi-structured questionnaire was administered to the respondents. Results: Most respondents (77.5%) were aware that the vector transmits the malaria parasite through biting. Fewer respondents would prevent malaria attacks by clearing the vegetation in the peri-domestic environment (13.5%), filling up potholes (16.9%), opening up drainage (11%), using insecticide-treated nets (25.7%) or using antimalarial drugs (11.2%). Less than one-tenth (8%) would use various other methods such as not accepting unscreened blood, while only 11% obtained the information from their teachers. Conclusion: The study identified knowledge gaps among school children. There is a need to empower teachers with information about the cause of malaria and prevention strategies.
Mary Slessor Journal of Medicine, Mar 23, 2009
Asian Pacific Journal of Tropical Medicine, Feb 1, 2010
African Journal of Primary Health Care & Family Medicine, 2010
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Papers by Ndifreke UDONWA