Aim/Objectives:This study aims to ascertain the prevalence and influencing factors of diabesity among adult patients visiting the General Outpatient clinic of three government healthcare facilities in Calabar, Nigeria. The objective is to enhance healthcare delivery to at-risk patients. Methods:A cross-sectional descriptive study design incorporating a mixed method approach, including quantitative and qualitative components such as Focused Group Discussions (FGD) and Key Informant Interviews (KII), was employed. The study population consisted of 190 participants aged 18 to 72 years with a body mass index (BMI) of ≥ 30kg/m2, selected using a systematic random sampling technique and analysed using SPSS and Atlas.ti. Results:Sociodemographic variables indicated that the highest number of respondents fell within the 35-44 years (37.3%), with 83.7% being female and 76.8% married. Furthermore, 65.8% were classified as having class 1 obesity, while only 38% self-identified as obese. The occurrence of diabesity was found to be 12.6% (i.e., BMI ≥30 vs. FBS ≥ 7.0), with 38% of cases being previously undiagnosed. Qualitative assessment through KIIs and FGDs revealed that unhealthy diets and lack of exercise were major contributing factors to diabesity. Conclusion:This study has disclosed a 12.6% occurrence of diabesity within the study population, with 38% of cases being previously undiagnosed. Unhealthy diets, snacking, and lack of exercise were identified as significant indicators of diabesity.

Introduction: Reduction in salt intake improves blood pressure control and reduces the risk of hypertension and other noncommunicable diseases (NCDs). However, salt intake remains high among Nigerians. This study aimed to identify barriers and facilitators to salt reduction among hypertensive patients attending a family medicine clinic in southern Nigeria. Methodology: A focussed group discussion (FGD) exploring patients’ perceptions of the barriers and facilitators to salt reduction was conducted with 8 groups of purposefully selected 74 hypertensives who consumed excess dietary salt, stratified by age and sex, using an FGD guide. Thematic analysis was then performed using Nvivo ® version 12 pro. Ethical approval was obtained from Irrua Specialist Teaching Hospital (ISTH), and written informed consent was obtained from the patients before the FGD. Results: Respondents had a mean age of 51.96 ± 8.98 years. The majority were females (47, 63.5%) and had uncontrolled blood pressure (66, 89.2%). Five major themes were identified, from which several minor themes emerged. Respondents rated their overall health as good but expressed concerns about their poor blood pressure control. Identified barriers to salt reduction included family pressure, ignorance, ready availability and affordability of salt and lack of affordable alternatives. Facilitators of salt reduction were measuring the amount of cooking salt, removing salt from the dining table and providing substitutes. Respondents, however, expressed willingness to reduce their salt consumption. Conclusion: The study identified barriers and facilitators to salt reduction. There is a need to create awareness of the safe amount of salt to be consumed and provide safe and readily available alternatives.

BACKGROUND:Hypertension is a leading cause of morbidity and mortality globally. Over a quarter of patients with hypertension have uncontrolled hypertension. Lifestyle modification has been shown to improve blood pressure control, thus measures that would help patients with hypertension achieve positive lifestyle modification would improve BP control. The study aims to determine the effect of motivational interviews on lifestyle modification and blood pressure control among patients with hypertension attending the Family Medicine Clinics of Irrua Specialist Teaching Hospital (ISTH), Irrua, Nigeria.METHODS:The proposed study will be a randomised control trial (PACTR202301917477205). About 212 adults between 18 and 65 years with hypertension presenting to the Family Medicine Clinics of ISTH will be randomised into intervention and control groups. The intervention group will be given a motivational interview (MI) on lifestyle modification at the start of the study and monthly for 6 months in addition to standard care for the management of hypertension. The control group will be given standard care for the management of hypertension only without MI and seen monthly for 6 months. Both groups will be assessed at baseline and 6 months. At baseline, a qualitative technique will be used to determine the reason for not adopting lifestyle modification.STUDY OUTCOME:The primary outcome shall be lifestyle modification at 6 months while the secondary outcome shall be blood pressure control at 6 months.CONCLUSION:Findings from the study will provide cost-effective ways of blood pressure control and reduction in the disease burden of hypertension in Nigeria.

Hypertension and other chronic diseases like heart diseases, diabetes, cancers and chronic lung diseases are a significant cause of morbidity and mortality globally. Management of hypertension has been mainly pharmacological. Non pharmacological management through effective health education on healthy lifestyle modification and medication adherence has been shown to improve outcome in the management of chronic diseases including hypertension. Health education in Nigeria is currently physician driven making it difficult for patient to comply with treatment protocol and follow up. This has led to poor treatment outcome in the management of hypertension and other chronic diseases. Adopting shared decision making (SDM) through the use of motivational interviewing, a patient-driven, physician-directed counselling approach that helps patient resolves ambivalence through collaboration, evocation and autonomy. Motivational interviewing has been used successfully in other countries to effect positive behavioural change and improved health outcome. It has also been shown to improve adoption of healthy lifestyle and medication adherence. When incorporated into primary care practice in Nigeria, it will help improve outcome in the management of chronic diseases like hypertension

Restorative sleep is essential for the maintenance of overall health and for the prevention of chronic diseases, including hypertension. The aim of this study was to determine the effect of motivational interviewing (MI) on sleep quality in patients with hypertension. The study was a randomised controlled trial (PACTR202301917477205) of 250 adult patients aged 18 to 65 years (125 in each group) with hypertension presenting to the Family Medicine Clinics of Irrua Specialist Teaching Hospital, Irrua, Nigeria from April to December 2023. Patients were selected through systematic random sampling and randomised into intervention and control group with the intervention group having monthly sessions of motivational interviewing in addition to standard care for hypertension and the control group having standard care only. Data were analysed with Stata with level of significance set at p < 0.05. The participants had a mean age of 51.5 ± 10.0 years, were mostly females 156 (62.4

Objectives Restorative sleep is critical in preventing hypertension and other chronic diseases. Limited research has explored the relationship between sleep quality and hypertension in Africa. This study investigated the association between sleep quality and blood pressure control among hypertensive patients in Southern Nigeria.Design Cross-sectional study.Setting A rural tertiary hospital in Southern Nigeria, April to June 2023.Participants 250 systematically selected hypertensive adults. Participants completed a validated semistructured interviewer-administered questionnaire to assess their sleep patterns, including sleep duration, self-reported trouble sleeping and a history of clinical diagnosis of sleep disorders. Sleep patterns were categorised as restorative (healthy) or non-restorative (unhealthy). The blood pressure of respondents was checked and categorised as controlled (<140/90 mm Hg) or uncontrolled (≥140/90 mm Hg). Data were analysed descriptively using SPSS V.24.0Outcome measures Quality of sleep and blood pressure control.Results Respondents had a mean age of 51.5±10.0 years, with the majority being female (156, 62.4%), married (135, 54.0%) and belonging to the Esan tribe (125, 50.0%). The prevalence of restorative sleep was 36%, while the blood pressure control rate was 23.6%. An association was found between restorative sleep and blood pressure control (adjusted OR =4.38; 95% CI=2.37–8.10; p<0.0001). Respondents aged ≥60 years had 3.5 times higher odds of experiencing non-restorative sleep than those aged ≤40 years (aOR=3.46; 95% CI=1.37–8.74; p=0.009).Conclusion The study found an association between poor quality sleep and poor blood pressure control. Incorporating sleep assessments and interventions into comprehensive hypertension management strategies could be explored as a possible approach to improve sleep quality and enhance blood pressure control.Trial registration number PACTR202301917477205.

Urbanisation and advances in health technology have led to a reduction in communicable diseases. However, poverty, population growth, and the globalisation of unhealthy diets have resulted in a global upsurge of non-communicable diseases (NCD) like cancers, cardiovascular diseases, nutritional and metabolic diseases, endocrine disorders and respiratory diseases. Healthcare for NCDs remains a significant public health challenge. The primary management in Nigeria is currently pharmacological. However, non-pharmacological measures that are cost-effective and safe, with minimal side effects, are available for the prevention (primary and secondary) and treatment of NCDs. The impact of behavioural medicine in Nigeria remains limited despite the potential to significantly reduce the burden of NCDs and improve health and clinical outcomes. This is mainly due to insufficient investment in behavioural medicine research, inferior quality evaluation methods, lack of implementation of research outcomes, and poor interdisciplinary collaboration. Based on insights from the literature, this article discusses the need for behavioural medicine interventions and examines their application, effectiveness, and potential impact on NCDs. It also recommends more consideration of behavioural medicine in preventing and managing NCDs in Nigeria.

Abstract Introduction: Obesity can be a major problem due to its potential to cause a number of health issues, including high blood pressure, diabetes and other cardiovascular diseases. This study aimed to evaluate the association between obesity as assessed by body mass index (BMI), waist hip ratio (WHR) and waist height ratio (WHtR) and blood pressure control among patients with hypertension attending the Family Medicine Clinics of Irrua Specialist Teaching Hospital, Irrua, a semi-urban community in Edo State, southern Nigeria. Methods This was a cross-sectional study among 250 patients with hypertension attending the Family clinics of Irrua specialist Teaching hospital, aged 18 to 65 years. The anthropometric indices of consenting participants, including BMI, WHR, and WHtR were evaluated and blood pressure determined. Data was analysed using statistical package of Social Sciences version 24.0. Result Study participants had a mean age of 51.5 ± 10.0 years, with a mean BMI of 28.60 ± 5.71kg/m2. The median and interquartile range of the waist hip ratio and waist height ratio were 1.02 (1.01, 1.03) and 0.61 (0.58, 0.66) respectively. The proportion of obese participants, defined by WHtR, with uncontrolled BP was significantly higher than that for those with controlled BP (63.9% vs 47.5%; p = 0.024). Upon adjusting for sociodemographic variables, participants who were obese based on WHtR had 2.71 times the odds of having uncontrolled blood pressure compared to those who were not obese. This finding was statistically significant. (aOR = 2.71; 95% CI = 1.37–5.38; p = 0.004). Conclusion Anthropometric indices remain valuable predictors of blood pressure control. The WHtR, a measure of central obesity, compared to the BMI, was significantly associated with poor blood pressure control.

Background: Owing 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 (LMIC) of the world. If the knowledge of PCPs concerning COVID-19 is enhanced, awareness, perception and attitude towards patient care will improve. Consequently, maximum prevention and control will be achieved. 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 one thousand one hundred and twenty-six (1126) PCPs actively working in government primary, secondary and tertiary healthcare 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 was significantly higher compared to those in secondary and primary levels of care. Approximately fifty-five percent (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 in order 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.

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 study.CONCLUSION:There is need for public enlightenment on the essence of routine screening of family members of hypertensive patients, avoidance of obesity and reduction of salt intake in our meals.

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 medical history of the respondents. Blood sample of each respondent was obtained from the median cubital vein, analysed with haemoglobinometer and their haemogloin (Hb) level determined and classified. Results: The age of the respondents ranged from 15-49 years with mean and standard deviation of 26.62 + 6.29 years. Results obtained show that out of 375 pregnant women, 265 had Hb <11g/dl giving 70.67% of anaemia among them. While 18.49% had mild anaemia (Hb:10.0-10.9g/dl), 4.15% had severe anaemia(Hb:<7.0g/dl). Anaemia was statistically associated with rural residence (p=0.024), low educational status (p=0.02), low family income (p=0.003), being married (p=0.016), lower parity (p=0.000), late booking (p=0.001), non-use of family planning (p=0.000), non-use of insecticide-treated nets (p=0.000), febrile illness in index pregnancy (p=0.000) and poor nutrition (p=0.000). Conclusion: The prevalence of anaemia among pregnant women in the study is high. This has far-reaching negative implications on the health status of the women during pregnancy, delivery and puerperum and that of the fetus. The need for preconception counseling and screening, health and nutrition education, early booking, contraception, treatment and prevention of causes of febrile illness, priority to girl child education and overall poverty eradication measures and recommended.

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.

Cluster differentiation 4 (CD4) count estimation, which is not readily available in most resource poor settings in Nigeria, is an important indexdetermining commencement of antiretroviral therapy (ART). It is imperative for physicians who come in contact with these patients in such settings to recognize other parameters to evaluate these patients. The clinical correlates of diarrhea and gut parasites among human immunodeficiency virus (HIV)-seropositive patients attending our special treatment clinic were studied. Three hundred and forty consenting HIV-positive adult subjects were enrolled. Their stool and blood specimens were collected for a period of three months. Stool samples were analyzed for the presence of diarrhea and gut parasites. The patients were clinically evaluated by physical examination for the presence of pallor, dehydration, oral thrush, wasting lymphadenopathy, dermatitis, skin hyperpigmentation, and finger clubbing. Participants with diarrhea represented 14.1% of the population, while 21.5% harbored one or more parasites. In the subjects with diarrhea, 14.6% harbored gut parasites. The presence of diarrhea was associated with a low CD4 count. Clinically, oral thrush, wasting, and rashes were more reliable predictors of low CD4 count levels; whereas, the presence of pallor, dehydration, wasting, and rashes correlated with the presence of diarrhea. HIV patients presenting with pallor, dehydration, wasting, and rashes should be evaluated for the presence of diarrhea. The clinical variables associated with low CD4 count in this study may guide commencing antiretroviral therapy in resource poor settings.

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.Keywords: Adherence, CD4 count, Total lymphocyte count, Adult AIDS Clinical Trial Group

The emergence of a chronic medical illness such as Human Immune Deficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS) may be the time when people turn to the Sacred through spirituality and religion. HIV is a chronic illness that requires strict adherence to medication regimens that may be influenced by spirituality/religion. This study was aimed at finding the association between spirituality/religion and adherence to highly active antiretroviral therapy (HAART) in adult HIV/AIDS patients. This is a cross-sectional descriptive study of 370 patients. Adherence was measured using an adapted adult AIDS clinical trial group (AACTG) and visual analogue scale (VAS) tools. Spirituality was assessed using Functional Assessment of Chronic Illness Therapy-Spirituality Expanded (FACIT-Sp-Ex) scale, religiosity with Duke University Religion index (DUREL), and religious coping with Brief Religious Coping (RCOPE) scale. Adherence rates were 86.2 and 43.8% using AACTG and VAS tools, respectively. Statistical significant correlation was found between spirituality and adherence to HAART (r = 0.265; p = 0.00). Also, significant correlation was found between positive religious coping and adherence (r = 0.15, p = 0.003). Odds ratio indicated that female respondents were 1.6 times more likely to be adherent, compared with males. Similarly, every unit rise in spirituality score yielded a 1.3 times increased likelihood of adherence to HAART on multiple logistic regression of adherence to HAART with relevant predictors. Both spirituality and positive religious coping have positive influence on optimal adherence. Therefore, the training of health care personnel to assess and provide spiritual care and involvement of chaplains/religious leaders is advocated for improved adherence.

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 (X2=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.

Background: 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.