|Year : 2017 | Volume
| Issue : 2 | Page : 38-42
A comparative analysis of the awareness and practice of periodic health examination among workers of public and private establishments in Zaria, Northwestern Nigeria
Sunday Asuke1, Jesubunmi Mary Babatunde2, Muhammed Sani Ibrahim3
1 Department of Community Medicine and Primary Health Care, College of Health Sciences, Bingham University, Karu, Nassarawa State, Nigeria
2 Department of Geography, Faculty of Physical Sciences, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
3 Department of Community Medicine, Faculty of Medicine, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
|Date of Web Publication||30-Apr-2018|
Dr. Sunday Asuke
Department of Community Medicine and Primary Health Care, College of Health Sciences, Bingham University, Karu, Nassarawa State
Source of Support: None, Conflict of Interest: None
Introduction: Periodic health examination (PHE) serves as a medium through which the workpeople receive recommended interventions to help them remain in a state of fitness throughout their period of employment. This study comparatively analyzed the awareness and practice of PHE among workers in public and private establishments in Zaria, Kaduna State, Northwestern Nigeria. Materials and Methods: A cross-sectional, descriptive study was carried out among 115 workers in private and 140 in public establishments in Zaria town, selected through a multi-stage sampling technique. Data were collected using a structured, self-administered questionnaire containing close-ended questions. Data were analyzed using SPSS version 17.0. Results: The mean age of the workers was 34.04 ± 9.65 years in private and 40.94 ± 8.99 years in public establishments. Majority of the workers in public 106 (93.0%) and private 125 (89.3%) were aware of PHE, but only 42.0% in private and 44.3% in public establishments had a good practice. Conclusion: The awareness of PHE among workers in both public and private establishments in Zaria was high; however, the practice was generally poor. There is the need for an intervention study among the establishments that will help translate such high awareness into practice for their benefit.
Keywords: Periodic health examination, private, public, workers, Zaria
|How to cite this article:|
Asuke S, Babatunde JM, Ibrahim MS. A comparative analysis of the awareness and practice of periodic health examination among workers of public and private establishments in Zaria, Northwestern Nigeria. Arch Med Surg 2017;2:38-42
|How to cite this URL:|
Asuke S, Babatunde JM, Ibrahim MS. A comparative analysis of the awareness and practice of periodic health examination among workers of public and private establishments in Zaria, Northwestern Nigeria. Arch Med Surg [serial online] 2017 [cited 2018 Aug 16];2:38-42. Available from: http://www.archms.org/text.asp?2017/2/2/38/231635
| Introduction|| |
Periodic health examinations (PHEs) are objective assessments of the health of employees in relation to their specific jobs, to ensure they can do the job and will not be a hazard to themselves or others. The purpose of PHE is to ensure that the work people are fit for employment and that they remain in that state of fitness throughout their period of employment. The practice of PHE also known as screening dates as far back as 1347, making it an ancient practice. In addition, PHE provides baseline data and helps protect the community (and not just the sick in factories and industries), improve patients' lives as in prescriptive screening, and finally influence the acceptance of life insurance.
Annually, between 68 and 157 million new cases of occupational diseases arise as a consequence of various types of work-related exposures. Furthermore, in 2008, 36.1 million deaths occurred due to chronic or noncommunicable diseases (NCDs); majorly cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases. Of all the NCD deaths, 80% occurred in low- and middle-income countries with Africa having the overall highest mortality rate of 779/100,000 population.
PHE affords an opportunity for the early detection of these NCD and the institution of preventive strategies. These diseases put a great amount of pressure on social welfare and the health system, also leading to loss of person-hours, prolonged morbidity, and impoverished families.
PHE has been a fairly common finding in most developed countries. A study by Ferrari Goelzer  reported that in the developed world, it is about 50% of the workforce that has access to occupational health services at a place of work, while it is only 10% in the developing world. A study conducted among health workers in Nigeria corroborated this finding of a low practice of PHE.
Researchers have asserted that PHE does not have a significant effect on health outcomes , but will help deliver some preventive interventions that may also lessen patient's anxiety. However, a study by Akande and Salaudeen revealed that PHE may be useful in early detection and reduction of the duration of illness, saving cost, and improving prognosis.
Even though a lot of diseases are associated with risk factors such as tobacco use, physical inactivity, harmful use of alcohol, and unhealthy diet; the practice of PHE is still low in this environment. PHE is a strategy through which awareness can be created to mitigating a lot of these diseases and ultimately improving the quality of life among the workforce. Therefore, this study compared the awareness and practice of PHE among workers of public and private establishments in Zaria, Northwestern Nigeria.
| Materials and Methods|| |
This study was conducted in Zaria, a major town in Kaduna State, Northwestern Nigeria. It is made up of two local government areas (LGAs), Sabon Gari and Zaria. Transportation within and outside Zaria is largely by road. It has a network of roads connecting Zaria to Sokoto, Kano, Kaduna, and Jos. There is a mini airport located at the College of Aviation Technology about 15 km away from the old Zaria city. Zaria's population is a mix of civil servants, traders, and farmers, and the predominant tribe is Hausa–Fulani and other ethnic groups comprising mainly Yoruba, Igbos, and other minority tribes. There are 42 public and 32 private establishments within the area. Some of the prominent tertiary institutions in Zaria include Ahmadu Bello University and its Teaching Hospital, Federal College of Education, Nuhu Bamalli Polytechnic, School of Nursing and Midwifery ABUTH, and Nigerian College of Aviation Technology.
The study was a cross-sectional descriptive study. The study population comprised staff of public and private establishments in Zaria town. Those who worked in large-scale and medium-scale establishments and were also tenure staff were included with no gender restriction, while employees of establishments with 50 or less workers and all casual staff were excluded.
A multi-stage sampling technique was used to select the respondents. In the first stage, 14 establishments were selected from Sabon Gari LGA and six from Zaria LGA from the total of 74 establishments in Zaria town by way of stratified sampling method using proportional allocation. In the second stage, in each of the 20 establishments, 12 or 13 workers who met the inclusion criteria were selected by simple random sampling making a total of 255 workers.
A structured, self-administered questionnaire was used to collect data. The questionnaire had three sections covering sociodemographic characteristics, awareness, and practice of PHE.
Data collected were cleaned and analyzed using SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc. Any respondent who answered in the affirmative at least four out of the six questions was taken to have good practice while anyone that answered three or less correctly was taken to have poor practice.
| Results|| |
A total of 255 respondents participated in the study, 115 from private and 140 from public establishments. The mean age of the workers was 34.04 ± 9.65 years in the private and 40.94 ± 8.99 years in the public establishments. More than 80% of the respondents had tertiary education. There was no statistically significant difference between the sociodemographic characteristics of the respondents in the private and public establishments, except in age and marital status [Table 1] – those in public establishments being older and more likely married.
The proportion of respondents who were aware of PHE was 106 (93%) in the private and 125 (83.9%) in the public establishment [Table 2]. The most common source of information on PHE was the media, i.e. 37 (34.9%), in the private establishment and hospital, i.e. 50 (40.0%), in the public establishment. On the definition of PHE, most respondents in the private establishment 36 (35.6%) said that it was medical examination to assess fitness to work, while 48 (38.7%) of respondents in the public establishment said that it was medical examination done periodically while at work. Majority of respondents said that PHE should be done once in a year, 77 (80.2%) in the private and 100 (86.2%) in the public establishments. In all the variables used to assess source of information, definition of PHE, and number of times PHE should be done, there was no statistically significant difference between workers in the private and public establishments [Table 2].
|Table 2: Sources of information, definition, and number of times periodic health examination should be conducted|
Click here to view
There was no statistically significant difference in the practice of PHE between public and private establishments [Table 3]. In the private establishment, 47 (42.0%) have had PHE while 62 (44.3%) in the public establishment have had PHE. Of the respondents that have ever undergone PHE in the private establishment, 21 (44.7%) have undergone PHE once, while of the respondents in the public establishment, 28 (45.2%) have undergone PHE just once. Majority of the respondents had their last PHE 1 year ago, 29 (64.4%) in private and 26 (42.6%) in public establishments. Concerning feedback, 34 (77.3%) in the private establishment got feedback on PHE while 54 (88.5%) in the public establishment got feedback. In all, 35 (74.5%) reported improvement in lifestyle as a result of PHE in the private establishment and 39 (63.9%) in the public establishment [Table 4]. Among all of the variables used to assess practice, there was no statistically significant difference between the private and the public establishments [Table 4].
|Table 3: Cross-tabulation between public and private establishment on practice of periodic health examination|
Click here to view
| Discussion|| |
PHE is an important medium for the delivery of recommended preventive intervention packages and also useful in allaying patient anxiety and improving health status. Most of the respondents in both establishments were aware of PHE. This could be possibly due to the fact that a significant number of the respondents had tertiary education, indicating that they were literate and this could have accounted for the high awareness of PHE. This is similar to the findings of Illesanmi et al. from Southwestern Nigeria and of Eke et al. from Southeastern Nigeria. The major source of this awareness in the private establishment was the media, while in the public establishment, it was the hospital. The findings of this present study, however, contrast that of Southeastern  Nigeria which reported friends as a major source of awareness but corroborates the study from Southwestern Nigeria.
The high rate of PHE awareness reported among respondents in both sectors did not correspond with the level of practice. This implies that beyond awareness, other factors could come into play in the actual practice of PHE such as cost, willingness, and belief in the value of PHE as highlighted in some other studies.,, For example, belief in the value of PHE was associated with the uptake of clinical preventive services such as mammograms, pap smears, and colon cancer screening. About two-third of those who had undergone PHE were males. This is not surprising as more of the participants were males and females are mostly homemakers in the community where the study was conducted. Among those who had undergone PHE, majority had tertiary education, signifying that level of education could be a key factor in influencing the health-seeking behavior of the participants. This finding, however, contrasts findings from another study, where socioeconomic factors and nature of illness were major determinants.
A slight majority of the participants in the private establishments who had PHE were younger which was significant. This is further buttressed by the statistically significant difference that was evident between the age groups for the private and public establishments. This could probably be due to the recruitment process where private establishments will actually source for younger and active age groups so as to avoid accruing large bills on medical consultations. This finding is, however, in contrast with the study from the United States where those who had undergone PHE where older because the younger age group did not believe in the value of PHE.
Just a little below half of the workers in both establishments had undergone PHE at least once since being employed, denoting possibly that PHE is not well embraced despite the high awareness, buttressing earlier factors mentioned influencing PHE. Majority of the participants, about two-third and a little less than half in the private and the public establishments, respectively, had undergone PHE within the preceding year. This implies that the practice of PHE was more in private than public establishments though not statistically significant. This difference could be due to the retainership program of some private establishments, where their employees do not necessarily pay for medical bills out of pocket.
About 80% of respondents in both establishments that had undergone PHE got feedback which had resulted in two-third of the participants from both establishments having improved lifestyles. This finding corroborates the finding from a study in the USA  that participants' belief in the value of PHE are associated with the likelihood of their adhering to recommended interventions.
| Conclusion|| |
The awareness of PHE was high among workers in both private and public establishments. However, this did not translate to a commensurate practice of PHE. This is in spite of the fact that PHE is an important medium for the delivery of timely health interventions. The low uptake of PHE highlights the importance of other possible underlying factors. Therefore, there is the need for future studies which should focus on identifying these factors.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Guidotti, TL, Cowell JWF, Jamieson GG, Engelberg AL. Ethics in occupational medicine. A Practical Approach. Chicago: American Medical Association. 1989.
Akande TM, Salaudeen AG. Practice of periodic medical examination among hospital workers in a Nigerian teaching hospital. Nig Qt J Hosp Med 2004;14:206-10.
D'Souza MF. Early diagnosis and multiphasic screening. In: Bennett AE, editor. Recent Advances in Community Medicine. London: Churchill; 1978.
Sackett DL. Screening for early detection of disease: To what purpose? Bull N
Y Acad Med 1975;51:39-52.
The Economic Cost of Non-communicable Diseases in the Pacific Islands: A Rapid Stock Take of the Situation in Samoa. Tonga and Vanuatu: Final report, 2012.
Ferrari Goelzer BI. Occupational health – A requirement for development. World Health Forum 1998;19:60-7.
Boulware LE, Marinopoulos S, Phillips KA, Hwang CW, Maynor K, Merenstein D, et al.
Systematic review: The value of the periodic health evaluation. Ann Intern Med 2007;146:289-300.
Olsen DM, Kane RL, Proctor PH. A controlled trial of multiphasic screening. N
Engl J Med 1976;294:925-30.
Industries and Establishments in Sabon Gari and Zaria Local Government. Kaduna State, Sabon Gari Local Government Secretariat Information Unit. Dogarawa; 2012.
Boulware LE, Barnes GJ, Wilson RF, Phillips K, Maynor K, Hwang C, et al
. Value of the Periodic Health Evaluation. Evidence Report/Technology Assessment No. 136. AHRQ Publication No. 06-E011. Rockville, MD: Agency for Healthcare Research and Quality; 2006.
Illesanmi OS, Ommotosho B, Alele F, Amenkhienan I. Periodic medical checkup: Knowledge and practice in a community in South West Nigeria. Int J Public Health Res 2015;5:576-83.
Eke CO, Eke NO, Joe-Ikechebelu NN, Okoye SC. Perception and practice of periodical medical checkup by traders in South East Nigeria. Afr Med J 2012;3:24-9.
Cherrington A, Corbie-Smith G, Donald EP. Do adults who believe in periodic health examination receive more preventive services? Prev Med 2007;45:282-9.
Wilson S, Sisk RJ, Baldwin KA. Health beliefs of blue collar workers: Increasing self-efficacy and removing barriers. AAOHN J 1997;45:254-7.
Abdulraheem IS. Health needs assessment and determinants of health-seeking behaviour among elderly Nigerians: A house-hold survey. Ann Afr Med 2007;6:58-63.
] [Full text]
[Table 1], [Table 2], [Table 3], [Table 4]