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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 2  |  Issue : 1  |  Page : 12-15

Knowledge and perception of patients with sickle-cell disease about primary care providers in Zaria, North-West Nigeria


Department of Haematology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Date of Web Publication13-Sep-2017

Correspondence Address:
Abdulaziz Hassan
Department of Haematology, Ahmadu Bello University Teaching Hospital, Zaria
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/archms.archms_16_17

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  Abstract 


Background: Sickle-cell disease (SCD) is a common disorder worldwide, affecting 2% of the Nigerian population. Patients with SCD require emergency care, especially during crises. However, specialists are scarce in hospitals in most towns and cities of Nigeria. Effective primary care may be life-saving where there are no specialists. Objectives: To determine the knowledge, perception, and attitude of patients with SCD toward primary care in Zaria. Materials and Methods: It was a researcher-administered questionnaire-based cross-sectional study of patients attending the adult SCD clinic of Ahmadu Bello University Teaching Hospital, Zaria. Results: There were 78 respondents including 55 (70.5%) females and 23 (29.5%) males. The median and interquartile range age of respondents was 22 (7) years. Most respondents have attained secondary (58.1%) and tertiary (35.5%) levels of education. Fifty-six (71.8%) respondents have visited a primary care facility in the past. While 24/76 (31.6%) respondents felt that the nonspecialist doctor was the major primary care provider, 8/76 (10.5%) each felt that the community health officer and the chemists were the primary care providers. Bone pain (26, 66.7%) was the main reason for seeking primary care. However, 8 (14.3%) respondents felt that services were poor and 4 (7.1%) felt that services were excellent at primary care centers. Conclusion: SCD patients have a fair understanding of primary care; however, there is low patronage and poor perception about the quality of care provided by the primary care providers.

Keywords: Perception, primary care, sickle-cell disease


How to cite this article:
Hassan A, Awwalu S, Okpetu L, Waziri AD. Knowledge and perception of patients with sickle-cell disease about primary care providers in Zaria, North-West Nigeria. Arch Med Surg 2017;2:12-5

How to cite this URL:
Hassan A, Awwalu S, Okpetu L, Waziri AD. Knowledge and perception of patients with sickle-cell disease about primary care providers in Zaria, North-West Nigeria. Arch Med Surg [serial online] 2017 [cited 2018 Aug 16];2:12-5. Available from: http://www.archms.org/text.asp?2017/2/1/12/214557




  Introduction Top


Sickle-cell disease (SCD) is a common disorder worldwide and in Nigeria it is said to affect 2% of the population.[1] Patients with SCD require routine care because of the constant state of hemolysis and recurrent hypoxia and infarction with multiorgan involvement in these patients.[2] Specialist hematologists and pediatricians are not readily available in most hospitals, especially in rural and semi-urban areas in Nigeria.

The World Health Organization estimates that approximately 5% of the world's populations carry the gene for hemoglobin disorders, mainly SCD and thalassemia.[3] In Africa, 10%–40% of the population carries the hemoglobin S gene with an estimated prevalence of 2% for SCD.[4] SCD is characterized by abnormal-shaped red blood cells which have a shortened life span.[3],[4]

In most African countries where SCD is a major health concern, SCD control programs do exist. However, they do not have national coverage and basic facilities for the management of patients are unavailable. Formal screening programs are unavailable, and patients are diagnosed for the first time when severe complications have occurred.[5]

Nigeria is said to be undergoing a demographic transition with a concomitant increase in risk factors for noncommunicable diseases (NCDs). Among the NCDs, SCD is estimated to cause about 100,000 deaths among infants annually or 8% of infant mortality rate in Nigeria.[5]

It is pertinent therefore that Nigeria should ensure effective management of SCD at different levels of the health-care system through the use of simple, reliable, affordable technology that will be readily accessible to a large proportion of the country.[5]

It is thus important that SCD control programs are preferred instead of a combined control program which may be too expensive and unsustainable. The program should be developed at the primary care level with appropriate technical and patient referral support from higher levels of care. Training of health personnel in prevention, diagnosis, and case management should ensure that the health-care system can provide the basic requirements of these services. Family- and community-based care should be an integral part of the national program.

Primary care is health care received at the basic nonspecialist level, especially for people making an initial visit to a nonspecialist, nurse, or other health-care providers.[6] In Nigeria, the goal of the National Health Policy is to bring about a comprehensive health-care system. The system is based on primary health care with health promotion and protection as cardinal principle. Primary health care is to provide preventive, restorative, and rehabilitative care to all citizens within the available resources. It is to provide both individuals and communities the assurance of productivity and social well-being;[7] thus, in Western countries, standard treatment guidelines have been made available for the care of children and adults with SCD.[8]

However, the nonspecialist primary care physicians (PCPs) may not have received appropriate training on pathophysiology, diagnostics, and standard care of treatment for SCD.[9] Thus, most patients with SCD who seek primary care may not get the best of care.

These problems are compounded by the lack of clear guidelines in the training curriculum of PCPs for the requisite competencies in terms of pathophysiology of SCD, treatment options available, diagnostic tests, and counseling skills in the management of SCD.[9] Currently, in Nigeria, even among the tertiary health centers, there is a paucity of diagnostic equipment and trained staff to cater for the teeming number of patients with SCD who seek care.[10]

Primary care for patients with SCD is the immediate first aid care by a nonspecialist physician that is given to patients with SCD when they present with acute or chronic complications to health-care facilities. The primary care provider is defined as physicians who are not trained in the primary care specialties of family medicine, general internal medicine, or general pediatrics but providing primary care to patients. The frequency of visit to PCP by patients with SCD and their perception of the quality of care provided have not been studied in our environment, thus the need for this study.


  Materials and Methods Top


This was a descriptive, cross-sectional study with the aid of interviewer-administered semi-structured questionnaires over a 4-week period. Respondents were patients attending the adult SCD clinic of Ahmadu Bello University Teaching Hospital, Zaria, North-West Nigeria. Ethical clearance was obtained from the Health Research Ethics Committee of the hospital.

The questionnaires consisted of a section on sociodemographic characteristics, knowledge of and attitude of patients to primary care providers, and likely steps to improve primary care services for patients with SCD. Data obtained were entered into SPSS statistical software version 20 (IBM, Chicago, IL, USA) and analyzed using descriptive statistics.


  Results Top


A total of 94 participants with SCD were enrolled; however, only 78 questionnaires were properly filled and returned. The median (inter quartile range) age of the respondents was 22 (7) with females and males constituting 55 (70.5%) and 23 (29.5%), respectively. Most respondents have had at least secondary school education 41(52.6%) [Figure 1].
Figure 1: Educational levels of respondents

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The median distances traveled by participants to primary care facility and tertiary hospital nearest to them were 1 (1.5) km and 11 (12) km, respectively. While 24/76 (31.6%) respondents felt that the nonspecialist doctor is the major primary care giver, 8/76 (10.5%) respondents each felt that the community health officer (CHO) and the chemists were the major primary care provider [Figure 2].
Figure 2: Respondents' perception of who is a primary care giver (n = 76)

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Majority of the respondents (56, 71.8%) have utilized a primary care facility previously, of these 39/56 (69.6%) in the last 1 year. The perception of the quality of primary care facilities among those who have been there is shown in [Figure 3]. Among those who have been to a primary care facility in the last 1 year, the most common reason was bone pains (26, 66.7%) as depicted in [Figure 4]. Most (35/68, 51.7%) patients believed that primary care providers need more training to improve the quality of service provided as shown in [Table 1].
Figure 3: Rating of quality of primary care by respondents (n = 56)

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Figure 4: Reasons for seeking primary care (n = 39)

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Table 1: Respondents' perception of area(s) of need of primary care providers (n=68)

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  Discussion Top


This study determined the knowledge and utilization of primary care facilities by adult patients with SCD in North-West Nigeria. Majority (71.8%) of the respondents in this study sought medical care from nonspecialists in primary care facilities at some point in their life, indicating a high utilization of primary care providers.

Most of the participants had attained at least secondary education which is about 12 years of formal education and the majority (72, 92.3%) have secondary or tertiary education and thus may account for their preference to seek for care from specialist centers rather than primary care facilities despite the distance. This is in keeping with other studies which suggest that patients with SCD should seek specialist care from the onset of symptoms.[11]

However, most of the participants have a poor knowledge of a primary care provider, only 31.6% understanding that a primary care provider is a nonspecialist medical doctor while the rest of the responders (68.4%) believed that specialist doctor, CHO, nurse, or even a chemist attendant are primary care providers. This lack of knowledge about primary care givers may not be unrelated to the relatively lower literacy levels in the North-West geopolitical zone of Nigeria compared to the Southern parts of Nigeria;[12] and the fact that health education taught in Nigerian schools is fraught with challenges [13] and primary care is not part of the curriculum.

An equal proportion of participants (39.3%) each scored their experience of services in primary care facilities as fair or good, respectively, indicating that the patients are not satisfied with services provided by them. This is similar to the views expressed by patients about the quality of care received from general practitioners in a study by Aljuburi et al. in the UK.[14] The similarity may be due to universal expectation of quality services irrespective of location of the patients.

The major reason for seeking care at primary care facilities was bone pain in 66.7% of cases. This is not unexpected as the painful vaso-occlusive crisis is the most common symptom in patients with sickle-cell anemia.[10]

The opinion of respondents on how to improve services provided by PCP at primary care facilities showed that majority agree that training was the most important requirement for improving services while the others indicated that funding, staffing, or a combination of these factors is required to improve services. This view is in keeping with constrains noted by other researchers in Nigeria and includes a perception of poor services, nonintegration of some services, e.g., care of patients with SCD, and poor funding of primary care facilities.[15]


  Conclusion Top


There is low patronage of primary care facilities by patients with SCD. Painful crisis was the main reason for seeking care at primary care facilities nearest to their homes. However, most patients were not satisfied with the services provided. This calls for training and retraining of primary care providers on SCD management to cater for the high numbers of patients needing their services in Nigeria.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Aliyu Z, Tumblin A, Kato G. Current therapy of sickle cell disease. Haematologica 2005;90:7-10.  Back to cited text no. 1
    
2.
Inati A, Chabtini L, Mounayar M, Taher A. Current understanding in the management of sickle cell disease. Hemoglobin 2009;33 Suppl 1:S107-15.  Back to cited text no. 2
[PUBMED]    
3.
WHO. Resolutions of the Fifty-Ninth World Health Assembly. Vol. 79. Geneva: WHO; 2008. p. 410-6.  Back to cited text no. 3
    
4.
WHO. Sickle-Cell Disease: A Strategy for the WHO African Region. Geneva: WHO; 2010.  Back to cited text no. 4
    
5.
WHO. Nigeria Country Cooperation Strategy 2014-2019. Geneva: WHO; 2014.  Back to cited text no. 5
    
6.
AAFP. Primary Care. Policies, Published; 2015. Available from: http://www.aafp.org/about/policies/all/primary-care.html. [Last accessed on 2015 May 21].  Back to cited text no. 6
    
7.
Abdulraheem IS, Oladipo A, Amodu M. Primary health care services in Nigeria: Critical issues and strategies for enhancing the use by the rural communities. J Public HealthEpidemiol 2012;4:5-13.  Back to cited text no. 7
    
8.
NHS. Sickle Cell Acute Painful Episode: Management of an Acute Painful Sickle Cell Episode in Hospital; 2012.  Back to cited text no. 8
    
9.
Humphreys JV. The management of sickle cell disease in a primary care setting. J Family Med Prim Care 2012;1:56-8.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Galadanci N, Wudil BJ, Balogun TM, Ogunrinde GO, Akinsulie A, Hasan-Hanga F, et al. Current sickle cell disease management practices in Nigeria. Int Health 2014;6:23-8.  Back to cited text no. 10
[PUBMED]    
11.
Xavier Gomes LM, de Andrade Barbosa TL, Souza Vieira ED, Caldeira AP, de Carvalho Torres H, Viana MB. Perception of primary care doctors and nurses about care provided to sickle cell disease patients. Rev Bras Hematol Hemoter 2015;37:247-51.  Back to cited text no. 11
[PUBMED]    
12.
NPC. Demographic and Health Survey. Abuja: NPC; 2013.  Back to cited text no. 12
    
13.
Idehen CO, Oshodin OG. Factors affecting health instruction in secondary schools in Edo State, Nigeria. Ethno Med 2008;2:61-6.  Back to cited text no. 13
    
14.
Aljuburi G, Okoye O, Majeed A, Knight Y, Green S, Banarsee R, et al. Views of patients about sickle cell disease management in primary care: A questionnaire-based pilot study. JRSM Short Rep 2012;3:78.  Back to cited text no. 14
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15.
Alenoghena I, Aigbiremolen A, Abejegah C, Eboreime E. Primary health care in Nigeria: Strategies and constraints in implementation. IJCR 2007;3:74-9.  Back to cited text no. 15
    


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