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Okparavero A, Foster MC, Tighiouuart H, Gudnasin V, Indridason O, Gudmumdsdottir H, et

al. Prevalence and complications of chronic kidney disease in a representative elderly

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IAMMS Volume 1, Issue 2 (March – April 2019)

Table of Contents

Original Articles

Abubakar AU, Awosan KJ, Ibrahim MT, Ibitoye KP.

Knowledge and practice of school health program in primary and secondary

schools in Sokoto metropolis, Nigeria

Isah MB, Oche MO, Yunusa EU, Yunusa MA, Oladigbolu RA, Arisegi SA.

Perception, prevalence and correlates of depression among females

attending the Gynecological Clinic of Usmanu Danfodiyo University Teaching

Hospital, Sokoto, Nigeria

Falaki FA, Grema BA, Singh S, Jega RM, Kaoje AA, Arisegi SA.

Family functionality among elderly patients with chronic illnesses attending

the General Outpatient Clinic of Usmanu Danfodiyo University Teaching

Hospital, Sokoto, Nigeria

23-28

29-35

36-43

` Abubakar et al.: Knowledge and practice of school health program

International Archives of Medicine and Medical Sciences І March – April 2019 І Volume 1 І Issue 2 17

Knowledge and practice of school health program in primary and secondary schools in Sokoto metropolis, Nigeria

Auwal U. Abubakar

1*, Kehinde J. Awosan

1,2, Mohammed T. Ibrahim

1,2, Kehinde P. Ibitoye

3

1Department of Community Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria,

2Department of

Community Health, 3Department of Paediatrics, Usmanu Danfodiyo University, Sokoto, Nigeria

Background: School health program addresses the healthcare needs of a substantial proportion of the population in many developing countries, and it is majorly concerned with ensuring that school children are healthy and benefit maximally from their education. Aim: This study was conducted to assess the knowledge and practice of school health program in primary and secondary schools in Sokoto metropolis, Nigeria. Materials and Methods: A cross-sectional study was conducted among 87 head teachers (selected by a two-stage sampling technique) in the primary and secondary schools in Sokoto metropolis, Nigeria. A structured self-administered questionnaire was used to collect data on the research variables. Data were analyzed using IBM SPSS version 20 statistical computer software package. Results: Less than a tenth 7 (8.0%) of the 87 respondents had good knowledge of school health program. Less than half of respondents knew the components (26.4%), services and activities involved (46.0%) and the objectives (48.3%) of SHP. Practice of SHP services / activities was adequate in less than half 41 (47.1%) of the 87 schools. There was no significant difference (p > 0.05) in the knowledge and practice of SHP in the public and private schools. Conclusion: This study showed poor knowledge of SHP among the head teachers, and sub-optimal practice of SHP in the primary and secondary schools in Sokoto metropolis, Nigeria. Review of teachers’ training curriculum to make it comprehensive enough to incorporate all the vital aspects of SHP, and periodic training of teachers on SHP were suggested.

Keywords: Knowledge, practice, school health program, primary and secondary schools

INTRODUCTION School health program addresses the healthcare needs of a substantial proportion of the population in many developing countries. It consists of coordinated activities which contribute to the understanding, maintenance and improvement of the health of the school population (Azubuike and Nkanginieme, 2007). In Nigeria, children aged 5-14 years accounted for 28.3% of an estimated population of over 140 million people (NPC, Nigeria and ICF International, 2013); at this age, they are constantly undergoing major developmental changes (physical, mental and social); an efficient health services for them therefore takes care of a good proportion of the Nigerian population. School health program is majorly concerned with ensuring that school children are healthy and benefit maximally from their education. Specifically it aims to provide treatment and emergency care to ill children;

provide advisory and counseling services for pupils, their teachers and parents; educate children on healthy living; control communicable and non-communicable diseases; promote optimal sanitary condition in the school environment; and help children achieve optimal growth and development (Adetokunbo and Herbert, 2003). Although, the detailed organization of school health program varies from one place to the other, SHP focuses on integrated activities with 5 main components including healthful school environment, school health education, school health services, school nutrition program, and school, home and community relationship (FMoE Nigeria, 2006). A healthful school environment is an essential factor in achieving the overall goals of the school health program because it has implications for all areas of school health (FMoE Nigeria, 2006), and the school environment is

ABSTRACT

International Archives of Medicine and Medical Sciences

Original Article

Print ISSN: 2705-1404; Online ISSN: 2705-1412 DOI: https://doi.org/10.33515/iamms/2019.008/8

*Corresponding Author: Dr. Auwal U. Abubakar, Department of Community Medicine, Usmanu Danfodiyo University Teaching Hospital,

Sokoto, Nigeria. E-mail: [email protected]

Received: 12-03-2019 Revised: 17-04-2019 Published: 30-04-2019



Abubakar et al.: Knowledge and practice of school health program

24 International Archives of Medicine and Medical Sciences І March – April 2019 І Volume 1 І Issue 2

believed to play a pivotal role in the retention and learning outcomes of students (MoE Pakistan and UNESCO, 2010). Schools have a responsibility to educate their students and foster among them healthy and hygienic behavior. Students should be educated on the health risks they face at school and how to protect themselves and others against diseases and other forms of ill-health by adopting health promoting habits and practices (MoE Pakistan and UNESCO, 2010). School health services constitute an essential component of an effective school health program and for achieving “Education for All” inclusive of children with special needs. It is aimed at making the school a healthy setting for living, studying and working, and the services provided here include pre-entry medical and dental screening; keeping school health records; routine health screening and examination (including screening for visual and hearing defects); first-aid and emergency preparedness; referrals services; special needs integration services; counseling; control of communicable diseases; and mental health services (FMoE Nigeria, 2006; Adetokunbo and Herbert, 2003; Parks, 2011). Evidence from literature had established a strong link between nutrition and learning; healthy eating patterns are essential for students to achieve their full academic potentials, full physical and mental growth, and life-long health and well-being (FMoE Nigeria, 2006). Poor nutrition affects children’s ability to learn, and evidence from research has revealed how breakfast affects children’s cognition, behavior and school performance (Brown et al., 2008). Hunger and micronutrient deficiencies, particularly anemia have been shown to negatively affect school children’s ability to attend school, concentrate in class and complete schooling. Iron deficiency anemia is one of the most common micronutrient deficiencies amongst school-age children affecting around 50% of school-age children worldwide, thus reducing their ability to pay attention, participate and learn in school (Jukes et al., 2008). Poor nutrition has been identified as an underlying cause for poor school attendance, retention and achievement among children of school age in Nigeria (FMoE Nigeria, 2006). A midday meal is believed to be an important instrument for combating classroom hunger and promoting better learning (Singh and Mishra, 2010). To this end, the Home-Grown School Feeding and Health Programme (HGSFHP) was launched in Nigeria in September 2015 to provide one nutritionally adequate meal each school-day for all school children.

Schools operate within communities, which comprise individuals, groups and institutions. Also, learners and staff in schools come from homes located in the communities; therefore, teachers, community leaders, religious and social institutions, voluntary agencies, health workers, social workers, parents and school children should all be involved in promoting school, home and community relationship through collaborative efforts. Previous studies conducted in Nigeria and other places majorly reported poor knowledge of school health program among teachers. A study conducted in Danuphyu, Myanmar reported that 62% of the teachers had high level of knowledge of SHP (Htun et al., 2013). Another study conducted in Kayseri, Turkey reported poor knowledge of first-aid among teachers (Baser et al., 2007). A study conducted in Bahrain reported that the school teacher interviewed scored only around 50% on average for knowledge about common health problems (Alnasir and Skerman, 2004). A study conducted in Edo, South-south Nigeria (Ofovwe et al., 2007), reported poor knowledge of SHP among the teachers interviewed with a significantly higher proportion (p < 0.05) of teachers in private schools (93.1%) having poor knowledge of SHP as compared to those in public schools (48.3%). A similar study conducted among teachers in Osun State (Abodunrin et al., 2014), Nigeria, reported that overall knowledge of SHP was good in only about half (50.7%) of respondents. Conspicuously, previous studies conducted across Nigeria including Kogi State (Ogwu and Ayabiogbe, 2010), Edo State (Ofovwe and Ofili, 2007), Osun State (Abodunrin et al., 2014), and Oyo State (Ademokun et al., 2014) majorly reported inadequate practice of SHP in concomitant with the poor knowledge of SHP among the respondents in the respective studies. Considering the fact that the schools provide unmatched access to the large population of young people in Nigeria, the school health program therefore provides an opportunity for students to learn about and practice healthy behavior. Whereas, studies regarding the knowledge and practice of SHP have been conducted among teachers in a couple of states in Nigeria, little is known about the knowledge and practice of SHP among teachers in Sokoto, Nigeria. This study was conducted to assess the knowledge and practice of school health program in primary and secondary schools in Sokoto metropolis, Nigeria.



MATERIALS AND METHODS Study Design, Population and Area A cross-sectional study was conducted among head teachers in the primary and secondary schools in Sokoto metropolis, Nigeria, in August and September 2015. Sokoto metropolis is the capital city of Sokoto state, and also the seat of government. It comprises Sokoto North, Sokoto South and some parts of Dange-Shuni and Wamakko Local Government Areas (LGAs) (SURPB, 2012). There are 76 secondary and 298 primary schools in the metropolitan LGAs, some of which are owned by the federal government, some by the state government, while the rest are owned by private individuals. Only the heads teachers in primary and secondary schools registered by the government (as indicated in the list obtained from the State Ministry of Education and State Universal Basic Education Board) were considered eligible. Those working in newly registered schools that have been in operation for less than one year were excluded. Sample Size Estimation and Sampling Technique The sample size was estimated at 87 using the statistical formula for calculating the sample size for descriptive studies (Ibrahim, 2009) a 6.9% prevalence of good knowledge of school health program among head teachers in a previous study (Ofovwe and Ofilli, 2007), a precision level of 5%, and adjustment for a finite population of 374 head teachers in Sokoto metropolis (obtained from institutional records) and an anticipated 90% response rate. Eighty-seven head teachers were enrolled into the study. The eligible participants were selected by a two-stage sampling technique. At the first stage, 2 of 4 Local Government Areas (LGAs) in Sokoto metropolis (i.e., Sokoto South and Wamakko LGAs) were selected by simple random sampling using the ballot option. At the second stage, line listing of all the primary and secondary schools (public and private) in the selected LGAs was done, and 90 of 237 schools were selected by simple random sampling using the table of random numbers. Proportionate allocation was done in the selection of public and private schools in the selected LGAs. The head teachers of the selected schools (or their representatives) were enrolled into the study. Data Collection and Analysis A structured self-administered questionnaire was used to obtain information on the respondents’ socio-demographic characteristics, and their knowledge and practice of school health program. Two resident doctors and 3 final year medical students assisted in data

collection after pre-training on the conduct of survey research, the objectives of the study, selection of study participants, and use of the survey instrument. The questionnaire was pretested on 10 head teachers in Kware LGA, and appropriate corrections were made based on the deficiencies detected in the instrument during the pretesting. Data were analyzed using IBM Statistical Package for the Social Sciences (SPSS) version 20.0 software. Quantitative variables were summarized using mean and standard deviations, while qualitative variables were summarized using frequencies and percentages. The chi-square test was used to compare differences between proportions. All levels of significance were set at p < 0.05. Ethical Consideration Institutional ethical clearance was obtained from the Ethical Committee of Sokoto State Ministry of Health, Sokoto, Nigeria. Permission to conduct the study was obtained from the Honorable Commissioner, Ministry of Education, Sokoto State, Nigeria, and informed consent was obtained from the participants before commencing data collection.

RESULTS Respondents’ socio-demographic characteristics All the 87 questionnaires administered were adequately completed and found suitable for analysis, giving a response rate of 100%. The ages of the respondents ranged from 23 to 62 years (mean = 41.9 ± 9.3 years) with a larger proportion 33 (37.9%) in the 30-39 years age group. Majority of respondents were males (79.3%), married (93.1%), practiced Islam as religion (81.6%), had tertiary education (97.7%), have spent less than 20 years in service (62.8%), and practiced in public schools (67.8%) as shown in Table 1.

Respondents’ knowledge of school health program Less than a tenth 7 (8.0%) of the 87 respondents had good knowledge of school health program. Less than half of respondents knew the components (26.4%), services and activities involved (46.0%) and the objectives (48.3%) of SHP. Whereas, majority of respondents knew teachers or the school health master (73.6%), health educator (62.1%), parent teachers association (54.0%), and sport and recreation experts (52.9%) as service providers in SHP, only about a third and less of respondents knew the other service providers in SHP (Table 2). Although, the proportion of respondents with good knowledge of SHP was slightly higher among those in public schools (8.5%) as compared to those in private schools (7.1%), the

difference was not significant (2= 0.046, p = 0.831).



Table 1: Respondents’ socio-demographic characteristics

Variables Frequency (%) n = 87

Age group (years)

20-29 5 (5.7) 30-39 33 (37.9) 40-49 25 (28.7) ≥50 24 (27.5)

Sex Female 18 (20.7) Male 69 (79.3)

Religion

Islam 71 (81.6) Christianity 16 (18.4)

Marital status

Single 6 (6.9) Married 81 (93.1)

Level of education

Primary 1 (1.1) Secondary 1 (1.1) Tertiary 85 (97.7)

Duration in service (years)

1-9 23 (26.4) 10-19 32 (36.4) 20-29 22 (25.3) 30-39 10 (11.5)

Type of school

Public 59 (67.8) Private 28 (32.2)

Practice of SHP services / activities in schools Practice of SHP services / activities was adequate in less than half 41 (47.1%) of the 87 schools. Most of the respondents reported practicing environmental sanitation (92.0%), transporting sick pupils /students to the health post (85.1%), health education (73.6%), and curative /first aid services (71.3%) in their schools. About two-thirds of the respondents reported keeping sickness and absenteeism records (69.0%), referring pupils / students to health facilities (63.2%), notifying the parents of referred pupils / students (60.9%) and offering immunization services 53(60.9%) in their schools, while only about a third below reported practicing the other SHP services / activities in their schools (Table 3). Four (57.1%) of the 7 schools whose head teachers had good knowledge of SHP offered adequate SHP services / activities as compared to 37 (46.2%) of the 80 schools whose head teachers had poor knowledge of SHP, but

the difference was not significant (2= 0.307, p = 0.580). The proportion of schools that offered adequate SHP services / activities was also higher in the private schools (53.6%) as compared to the public schools (44.1%), but

the difference was not significant (2= 0.688, p = 0.407).

DISCUSSION This study assessed the knowledge and practice of school health program in primary and secondary schools in Sokoto

metropolis, Nigeria. Majority, 59 (67.8%) of the 87 schools in this study were owned by government, this could be due to the fact that schools are seen as one of the social services to be provided by government in Northern Nigeria. This is in contrast to the finding in a study conducted in Edo State, South-western Nigeria, in which only about a fifth (21.8%) of the schools were owned by government (Ofovwe and Ofili, 2007).

Table 2: Respondents’ knowledge of school health program

Variables Correct response

Frequency (%) n = 87

Knowledge of school health program (SHP)

Components of SHP 23 (26.4) Services / activities in SHP 40 (46.0) Objectives of SHP 42 (48.3)

Service providers in SHP Medical officer 23 (26.4)

Community nurse 27 (31.0) Health educators 54 (62.1) Nutritionist / dietician 20 (23.0) Child psychologist 29 (33.3) Sport and recreation expert 46 (52.9) Teacher (health master) 64 (73.6) Parent teachers association 47 (54.0)

Knowledge grading Good 7 (8.0) Poor 80 (92.0)

The deficient concept of SHP which appears to prevail in Nigeria may play a vital role in the lack of adequate knowledge of SHP among head teachers of primary and secondary schools in this study. Furthermore, the common practice of employing graduates who are not professional teachers in private schools in Nigeria may explain the reason why higher proportions of head teachers in public schools had good knowledge of SHP as compared to those in private schools in this study and the latter studies. Practice of SHP was adequate in less than half of schools (47.1%) in this study, this could be due to the fact that majority of the head teachers in this study had poor knowledge of SHP. Even though the proportion of schools with adequate practice of SHP is relatively low in this study, it is comparable with the 52.6% prevalence of respondents that achieved high practice of SHP in a study conducted in Myanmar (Htun et al., 2013), and substantially higher than the 18.3% prevalence of adequate practice of SHP in a study among teachers in Osun State, Nigeria (Abodunrin et al., 2014). While the high levels of practice of SHP services / activities such as cleaning of school environment (92.0%), health education (73.6%), curative/first aid



services (71.3%), and immunization services (60.9%) in the schools are commendable, the low levels of practice of pre-entrance medical examination (12.6%), and periodic medical examination (10.3%) in the schools suggest poor understanding of the benefits of these practices by the respondents. This calls for concern, as it could undermine early detection and treatment of various defects/impairments (especially sight and hearing impairments) in pupils/students, thus affecting their learning, and resulting in poor performance (Adegbehingbe et al, 2005). These findings underscore the need for the management of teachers’ training institutions to make their curriculum comprehensive enough to incorporate all the vital components of school health program, while the Ministry of Education in conjunction with the operators of private schools should organize periodic training on SHP for teachers.

Table 3: Practice of school health services / activities in schools

Variables Schools involved

Frequency (%)

n = 87

Practice of SHP services / activities

Pre-entrance medical examination 11 (12.6) Periodic medical examination 9 (10.3) Periodic screening of teachers 7 (8.0) Periodic screening of food handlers 32 (36.8) Health education 64 (73.6) Immunization services 53 (60.9) Deworming of pupils 19 (21.8) Provision of school meal 21 (24.1) First aid / curative services 62 (71.3) Referral services 55 (63.2) Notification of parents following referral

53 (60.9)

Transportation of sick pupil / student to the hospital

74 (85.1)

Cleaning of school environment 80 (92.0) Reproductive health services 1 (1.1) Dental health services 19 (21.8) Counseling and psychotherapy 37 (42.5) Sickness and absenteeism record 60 (69.0)

SHP services / activities grading Adequate 41 (47.1) Inadequate 46 (52.9)

CONCLUSION This study showed poor knowledge of SHP among the head teachers, and sub-optimal practice of SHP in the primary and secondary schools in Sokoto metropolis, Nigeria. Management of teachers’ training institutions should make their curriculum comprehensive enough to incorporate all the vital components of school health program, while the Ministry of Education in conjunction with the operators of private schools should organize periodic training on SHP for teachers.

Acknowledgements The authors appreciate the Honorable Commissioner, Ministry of Basic and Secondary Education, Sokoto State, Nigeria, the Honorable Commissioner, Ministry of Health, Sokoto State, Nigeria, and all the head teachers that participated in the study for their cooperation. Source of support Nil. Conflict of interest None declared.

REFERENCES Abodunrin OL, Adeoye OA, Adeomi AA, Osundina FF, Ilori

OR (2014). Practice scope and determinant of school health services in Osun State, Nigeria. British J. Med. Med. Res. 4 (35): 5548 -5557.

Adegbehingbe BO, Oladehinde MK, Majemgbasam TO, Onakpoya HO, Osagiede EO (2005). Screening of adolescents for eye disease in Nigeria high schools. Ghana Med J. 39(4): 138-142.

Ademokun OM, Osungbade KO, Obembe TA (2014). A qualitative study on status of implementation of school health programme in South Western Nigeria: implication for healthy living of school age children in developing countries. American J. Edu. Res. 2(11): 1076-1087.

Adetokunbo OL, Herbert MG (2003). Short Textbook of Public Health Medicine for the Tropics. 4th ed. London, UK: Arnold Publishers.

Alnasir FA, Skerman JH (2004). School teacher knowledge of common health problems in Bahrain. Eastern Mediter. Hlth. J. 10 (4-5): 537-546.

Azuibuike JC, Nkanginieme KEO (2007). Paediatrics and Child Health in a Tropical Region. 2nd ed. Owerri, Nigeria: African Educational Service. Pp 22-55.

Baser EM, Coban S, Tuscai S, Sungur G, Bayat M (2007). Evaluating first-aid knowledge and attitudes of a sample of Turkish primary school teachers. J. Emerg. Nurs. 33(5): 428-32.

Brown JL, Beardslee WH, Prothrow-Stith D (2008). Impact of school breakfast on children’s health and learning, An analysis of scientific research. Commissioned by the Sedexo foundation. Available at: https://www.us.stop-hunger.org/files/live/stophunger-us/ [Last accessed on 2019 March 2].

Federal Ministry of Education (FMoE), Nigeria (2006) .Implementation Guidelines on National school Health Programme. Abuja, Nigeria: FMoE, Nigeria.

Htun YM, Lwin KT, Oo NN, Soe K, Sein TT (2013). Knowledge, attitude and reported practice of primary school teachers on specified school health activities in Danuphyu Township, Ayeyarwaddy Region, Myanmar. South-East Asia J. Pub. Hlth. 3(1): 24-29.

Ibrahim T, (2009). Research Methodology and Dissertation Writing for Health and Allied Health Professionals. Abuja, Nigeria: Cress Global Link Limited.

https://www.us.stop-hunger.org/files/live/stophunger-us/

https://www.us.stop-hunger.org/files/live/stophunger-us/



Jukes MCH, Drake LJ, Bundy DAP (2008). School Health,

Nutrition and Education for All, Levelling the Playing Field. Cambridge, USA: CABI Publishing.

Ministry of Education, Curriculum Wing, Government of Pakistan, United Nations Educational, Scientific and Cultural Organization (UNESCO) (2010). School Health Programme: A strategic Approach for Improving Health and Education in Pakistan. Islamabad, Pakistan: MoE Pakistan, UNESCO. Available at: https://www.unesco.org.pk/education/documents/publications/School%20Health%20Programme.pdf [Last accessed on 2019 March 2].

National Population Commission (NPC) (Nigeria) and ICF International. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria and Rockville, Maryland, USA: NPC and ICF International.

Ofovwe GE, Ofili. AN (2007). Knowledge, attitude and practice

of school health programme among head teachers of primary schools in Egor local government area of Edo state, Nigeria. Annals Afr. Med. 6(3): 99-103.

Ogwu DA, Ayabiogbe CI (2010). School health services in public and private senior secondary school in Kogi State. Nig. J. Hlth. Edu.14 (1): 232-247.

Park K (2011). Parks Textbook of Preventive and Social Medicine. 21st ed. Jabalpur, India: Banasidar Bhohat.

Singh M, Mishra N (2010). Evaluation study on midday meal programme in Meghalaya. Hyderabad, India: Council for Social Development, Southern Region Centre. Available at: https://www.righttoeducation.in/sites/default/files/MDM-FINAL-REPORT.pdf [Last accessed on 2019 March 2].

How to cite this article: Abubakar AU, Awosan KJ, Ibrahim MT, Ibitoye KP (2019). Knowledge and practice of school health program in primary and secondary schools in Sokoto metropolis, Nigeria. Int. Arch. Med. Med. Sci, 1(2): 23-28.

https://www.unesco.org.pk/education/documents/publications/School%20Health%20Programme.pdf

https://www.unesco.org.pk/education/documents/publications/School%20Health%20Programme.pdf

https://www.righttoeducation.in/sites/default/files/MDM-FINAL-REPORT.pdf

https://www.righttoeducation.in/sites/default/files/MDM-FINAL-REPORT.pdf

` Isah et al.: Perception, prevalence and correlates of depression among females


Perception, prevalence and correlates of depression among females attending the Gynaecological Clinic of Usmanu Danfodiyo University

Teaching Hospital, Sokoto, Nigeria

Mohammad B. Isah1*

, Oche M. Oche4, Edzu U. Yunusa

4, Mufutau A. Yunusa

5,

Remi A. Oladigbolu2, Sarafadeen A. Arisegi

3

1Department of Obstetrics and Gynaecology,

2Department of Community Medicine,

3Department of Family Medicine, Usmanu

Danfodiyo University Teaching Hospital, Sokoto, Nigeria, 4Department of Community Health,

5Department of Psychiatry,

Usmanu Danfodiyo University, Sokoto, Nigeria

Background: Infertility is a global problem, particularly in developing countries, and it has been linked with emotional responses such as depression, anxiety, guilt, social isolation, and decreased self-esteem in both men and women. Aim: This study was conducted to assess the perception, prevalence and correlates of depression among females attending the Gynecological Clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Materials and Methods: A cross-sectional study was conducted among 156 females with infertility (selected by systematic sampling technique) in Sokoto, Nigeria. A structured interviewer-administered questionnaire was used to collect data on the research variables. Data were analyzed using IBM SPSS version 20 statistical computer software package. Results: The mean age of the respondents was 28.3 ± 6.4 years. Majority, 113 (72.4%) of the 156 respondents perceived the need to share their feelings concerning the delay they had in having a child with others, but close to half of them (48.7%) had fears of adverse consequences after doing so. About a fifth of respondents (21.8%) had depression and it was associated with being married for ≤ 3 years, having negative attitude to child adoption, and poor support from in-laws. Conclusion: This study showed high levels of perception of the benefits and consequences of sharing their feelings regarding their infertility with others, and high prevalence of depression among females with infertility in Sokoto, Nigeria. Care providers should promote child adoption among women undergoing fertility treatment, routinely screen them for depression and include their extended family members in the interventions for preventing depression among them.

Keywords: Perception, prevalence, correlates, depression, infertility, females

INTRODUCTION Infertility (defined as the inability to conceive after one year of regular intercourse of about 3-4 times per week without contraception) is a global problem particularly in developing countries, and it has been estimated to affect 1 in 3 couples in the Central- and West-African countries, and 10-15 percent of all couples of fertile age in industrialized countries (Okonofua, 2005; Makar and Toth, 2002; Maheshwari, 2008; Statistics Sweden, 2007). According to the World Health Organization (WHO), about 60% of infertility cases in Africa are attributable to genital tract infections in males and females as compared to other regions of the world, with 30-40% of cases being due to the man, and 30-40% of cases being due to the woman; but paradoxically, the female is held

responsible for virtually all cases of infertility in Africa (WHO, 2010; Okonofua, 2005; Robinson and Stewart, 1996). The African society places passionate premium on procreation in any family setting, and as such, the woman’s place in marriage remains precarious until it is confirmed through childbearing. Also, children are held as sources of pride, strength and economic fortune for the family, with a man's wealth and strength being equated to his progeny. Infertility is therefore considered as a serious problem in Africa and a major crisis in the affected family with negative impacts on the couple’s mental and social well-being (Okonofua, 2005).


ABSTRACT


Original Article


*Corresponding Author: Dr. Mohammad B. Isah, Department of Obstetrics and Gynaecology, Usmanu Danfodiyo University Teaching

Hospital, Sokoto, Nigeria. E-mail: [email protected]



Isah et al.: Perception, prevalence and correlates of depression among females


In addition, the attendant emotional, psychological, cultural and social burdens drain the couple of self-belief and esteem; the unsolicited and often inpatient societal demands and expectations place on couples unimaginable pressure and tension, and they may become isolated and neglected consequent upon the attendant social stigmatization (Ljubin-Sternak, 2014). Also, infertility may lead to physical, emotional and financial burden; and other problems such as marital conflicts, poor self-esteem, and lack of satisfaction with sexual performance / reduced frequency of sexual intercourse, thus perpetuating the problem (Monga et al., 2004; Andrews et al., 1991; Ulbrich et al., 1990). It is therefore evident that infertility has a great impact on the quality of life and marital status of the affected couples. Studies conducted in both developed and developing countries have documented several psychological complications of childless marriages (Matsubayashi et al., 2004; King, 2003; Dyer et al., 2005; Sami and Ali, 2006), and infertility has been linked with emotional responses such as depression, anxiety, guilt, social isolation, and decreased self-esteem in both men and women (Abbey et al., 1991; Greil, 1997; Morin-Davy, 1998). The prevalence of depression in infertile couples has been found to increase in recent years from 44% in the first half of the decade of the 2000s to 50% in the second half (Masoumi et al., 2013). It is estimated that about 40% of infertile couples experience anxiety and 86% experience depression, and several correlates of depression have been identified in infertile couples (as these factors influence their vulnerability to depression); these include previous history of depression, preexisting stressful life event, personality factors, previous reproductive failure and genetic predisposition; and exposure to stressful life events is believed to be higher among subjects with a history of depression (Caplan et al., 2000; Williams and Zappert, 2006; Kendler et al., 2000). The risk factors for depression and anxiety in the general population include low socioeconomic status, smoking, drug and alcohol abuse, being single and being unemployed (Baumeister and Harter, 2007; Anderson et al., 2004). In Africa, women with fertility problems may be despised, neglected and abused by the husband and her in-laws (Dyer et al., 2005). Their exclusion from some important social events has been noted in some parts of Nigeria and Mozambique (Orji et al., 2002; Gerrits,1997). Despite these observations, the impact of the experience of infertility on women’s mental health is an area that is currently under researched in sub-Saharan

Africa and Nigeria in particular. In Nigeria, infertility is the commonest presenting complaint among gynaecological patients and about 2 of every 5 patients complain of infertility, and it now constitutes a major burden on the clinical service delivery in Nigeria, accounting for more than 50% of gynecological caseloads and over 80% of laparoscopic investigations (Idrisa et al., 2001; Isawumi, 2011); and with institutional-based prevalence rates of 4.0, 15.4, and 48.1% in studies conducted in Ilorin (North-central Nigeria), Abakaliki (South-east Nigeria), and Osogbo (South-west Nigeria) respectively (Abiodun et al., 2007). With the establishment of a Facility Unit in the hospital, and the creation of awareness of the services among the populace in Sokoto State and the neighboring states, the numbers of infertile couples presenting for treatment of infertility has increased dramatically. Whereas, a previous study conducted in Sokoto, Nigeria (the study area) had reported 15.7% prevalence of infertility among women attending the gynecological clinic of UDUTH, Sokoto, Nigeria, virtually nothing is known about the burden of depression, its effects on the psychological well-being of those affected, and its correlates among infertile females in this area. This study was conducted to determine the perception, prevalence and correlates of depression among females attending the Gynecological Clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.

MATERIALS AND METHODS Study Design, Population and Area A cross-sectional study was conducted among females with infertility attending the Gynecological Clinic of Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria, in November 2016. The hospital has a bed capacity of 800 and serves Sokoto State and the neighboring states of Kebbi and Zamfara, as well as the neighboring Niger Republic. The Fertility Unit is one of the 4 firms under the Obstetrics and Gynecology Department (the other firms include Feto-maternal, Oncology and Urogynecology). All infertile females (irrespective of type of infertility, and whether or not they were under treatment) attending the Gynecological Clinic of UDUTH within the period of the study and gave their informed consent to participate were considered eligible and enrolled into the study. Sample Size Estimation and Sampling Technique The sample size was estimated at 156 using the statistical formula for calculating the sample size for descriptive studies (Ibrahim, 2009) a 10.9% prevalence of depression among infertile women in a previous study



(Volgsten et al., 2008), a precision level of 5%, and an anticipated 95% response rate. The eligible participants were selected by systematic sampling technique. Four gynecological clinics are run in a week, and about 30 patients are seen per clinic, making a total of 120 patients per week. One of 2 infertile females presenting consecutively at the clinic over a period of 3 weeks was enrolled into the study until the estimated sample size of 156 was obtained. Data Collection and Analysis A structured interviewer-administered questionnaire (adapted from the instrument used in previous studies) (Oliver et al., 2014; Upkong and Orji, 2006; Masoumi et al., 2013) was used to obtain information the participants’ socio-demographic characteristics, their perception of depression, and the correlates of depression among them. The Beck Depression Inventory (Beck, 1979) was used to screen for depression among the participants. The Beck Depression Inventory (BDI) is a 21-item survey tool. Each question contains four response options ranging from zero to three, with the higher rating indicating a more severe symptom of depression. The total ranges of potential total scores vary from 0 to 63. Scores of 0-10 are considered as normal ups and down, 11-16 indicate mild mood disturbance, 17-20 indicate borderline clinical depression, 21-30 indicate moderate depression, 31-40 indicate severe depression, and scores of 40 and above indicate extreme depression (Beck, 1979). Four doctors (House Officers) were recruited to assist in data collection, after being trained on the objectives of the study, conduct of survey research, interpersonal communication skills and use of survey instrument. The questionnaire was pretested on 20 females attending the Gynaecological Clinic of Specialist Hospital, Sokoto, Nigeria (another tertiary health care facility in Sokoto, Nigeria) immediately after the training of the research assistants to assess its appropriateness, and to familiarize the research assistants with it. The questions were well understood and no modification was necessary. The questionnaires were manually checked for accuracy and completeness. Data were cleaned, entered into and analyzed using the IBM Statistical Package for Social Sciences (SPSS) version 20. Quantitative variables were summarized using mean and standard deviation while categorical variables were summarized using frequencies and percentages. The chi-square test was used to compare differences between proportions. All levels of significance were set at p < 0.05.

Ethical Consideration Institutional ethical clearance was obtained from the Ethical Committee of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Permission to conduct the study was obtained from the Management of the hospital, and informed consent was obtained from the participants before administering the questionnaires.

RESULTS Respondents’ socio-demographic characteristics All the 156 questionnaires administered were adequately completed and found suitable for analysis, giving a response rate of 100%. The mean age of the respondents was 28.3 ± 6.4 years with a larger proportion 65 (41.7%) of the 156 respondents being in the 18-25 years age group. Majority of respondents were Muslims (76.9%), and a larger proportion of them had tertiary education (37.8%), and were either full-time housewives (46.2%) or civil servants (43.3%). Majority of respondents (51.9%) were in monogamous marriage (Table 1).

Table 1: Respondents’ socio-demographic characteristics


Age group (years)

18-25 65 (41.7) 26-30 42 (26.9) 31-36 27 (17.3) ≥37 22 (14.1)

Religion

Christianity 36 (23.1) Islam 120 (76.9)

Level of education

None 43 (27.6) Primary 21 (13.5) Secondary 33 (21.1) Tertiary 59 (37.8)

Occupation (n = 143)

Unemployed 2 (1.4) Civil servant 62 (43.3) Farming 4 (2.8) Business 9 (6.3) Full-time housewife 66 (46.2)

Type of marriage

Monogamous 81 (51.9) Polygamous 75 (48.1)

Perception of depression among respondents Close to half, 76 (48.7%) of the 156 respondents had fears about others knowing their feelings concerning the delay they had in having a child, with the most common sources of fears being that people might start gossiping about them (41.0%), being divorced (39.7%), and in-laws encouraging their spouses to marry another wife (10.3%). Majority of respondents (72.4%) believed that it



is important to share their feelings with others, and would prefer to share their feelings with their parents (66.0%). Majority of respondents (62.2%) also believed that sharing their feelings with others would reduce self-burden and promote self-confidence (Table 2).

Table 2: Perception of depression among respondents

Variables Frequency (%)

n = 156

Had fears about others knowing their feelings concerning the delay in having a child

Yes 76 (48.7) No 40 (25.6) No response 40 (25.6)

Main source of fear Might be kicked out of home 62 (39.7)

People might gossip about them 64 (41.0) In-laws might encourage their spouses to leave them

10 (6.4)

Might be discriminated against 4 (2.6) In-laws might encourage their spouses to marry another wife

16 (10.3)

Believed it is important to let others know their feelings about the delay in having a child

Yes 113 (72.4) No 43 (27.6)

Who they believed should be informed about their feelings

Spouse 27 (17.3) Co-wives 18 (11.5) Parents 103 (66.0) Friends 8 (5.1)

Perceived benefits of telling others about their feelings

Encourages family support 24 (15.4) Reduces self-burden and promotes self-confidence

97 (62.2)

Promotes sexual satisfaction 6 (3.4) Do not know 29 (18.6)

Prevalence of depression among respondents Thirty-four (21.8%) of the 156 respondents in this study had depression, with 29 (18.6%) having mild depression, while 5 (3.2%) had moderate depression (Figure 1). Correlates of depression among respondents Majority, 117 (75.0%) of the 156 respondents have been married for more than 3 years, and majority of them (72.4%) had no child. Most of the respondents (80.1%) had negative attitude towards child adoption. About a fifth of respondents (20.5%) had poor support from their husbands, while majority of them (60.3%) had poor support from their in-laws (Table 3). The proportion of respondents with depression was significantly higher among respondents that have been married for ≤ 3 years (43.6%) as compared to those in

the other groups (ranged from 0 to 31.6%) 2= 23.731, p < 0.001; it was significantly higher among respondents with negative attitude towards child adoption (79.2%) as compared to those with positive attitude towards it

(40.0%) 2= 4.948, p = 0.026; and among those with poor support from in-laws (92.3%) as compared to

those with good support (55.0%) 2= 5.192, p = 0.023. The proportion of respondents with depression was higher among respondents with no child (72.7%) as compared to those with at least a child (58.3%), and among those with poor support from their husbands (80.0%) as compared to those with good support, but the differences were not significant (p > 0.05) as shown in Table 4.

Figure 1: Prevalence of depression among

respondents

Table 3: Correlates of depression among respondents

Variables Frequency (%)

n = 156

Duration of marriage (years)

1-3 39 (25.0) 4-6 46 (29.5) 7-9 33 (21.2) ≥ 10 38 (24.4)

Not having at least a child Yes 113 (72.4) No 43 (27.6)

Had negative attitude towards adoption Yes 125 (80.1) No 31 (19.9)

Poor support from husband Yes 32 (20.5) No 124 (79.5)

Poor support from in-laws Yes 94 (60.3) No 62 (39.7)



Table 4: Distribution of depression by its correlates among respondents

Variables Depression status Test of significance

Not depressed

Frequency (%)

Depressed

Frequency (%)

Duration of marriage (years)

1-3 22 (56.4) 17 (43.6)* 2= 23.731, p < 0.001 4-6 40 (87.0) 6 (13.0)

7-9 33 (100) 0 (0) ≥ 10 27 (68.4) 11 (31.6)

Not having at least a child Yes 6 (27.3) 16 (72.7)

2= 0.735, p = 0.391 No 5 (41.7) 7 (58.3)

Had negative attitude towards adoption

Yes 5 (20.8) 19 (79.2)* 2= 4.948,

p = 0.026 No 6 (60.0) 4 (40.0)

Poor support from husband Yes 1 (20.0) 4 (80.0)

2= 3.409, p = 0.523 No 10 (34.5) 19 (65.5)

Poor support from in-laws Yes 1 (7.7) 12 (92.3)*

2= 5.192, p = 0.023 No 9 (45.0) 11 (55.0)

*Statistically significant

DISCUSSION This study assessed the perception, prevalence and correlates of depression among females attending the Gynecological Clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Although, majority of the respondents in this study (72.4%) believed that it is important to share their feeling concerning the delay they had in having a child with others, and were aware of the benefits of doing so (including reduction of self-burden and promotion of self-confidence), close to half of them (48.7%) had fears in telling others about it. This could be due to the fact that in Sokoto, Nigeria (similar to the situation in many developing countries), children are highly valued for cultural, social and economic reasons; and childlessness often creates huge problems for couples, especially for women who are generally blamed for the infertility. The stigma of childlessness is so great in many developing countries that infertile women are socially isolated and neglected even by the people who are supposed to support them, such as their husbands and extended family; and motherhood is often the only way for women to enhance their status within their family and community. It is therefore easy to understand why large proportions of the respondents in this study had fears of people gossiping about them (41.0%), being divorced (39.7%), and in-laws encouraging their spouses to marry another wife (10.3%) if they share their feeling with others; and it is not surprising that majority of them (66.0%) would prefer to share their feelings with their parents.

The 21.8% prevalence of depression among the respondents in this study is quite high even though it is substantially lower than the rates obtained in studies conducted in Nigeria (42.9%) (Upkong and Orji, 2006) and other places including Ghana (62.0%) (Alhassan and Abaidoo, 2012), and Iraq (68.9%) (Al-Asadi and Hussein, 2015). The high prevalence of depression in this study and the latter studies buttresses the psychological challenges that childless women are confronted with in many developing countries across the globe. In many developing countries including Nigeria children are seen as a form of social security in old age and as a means of perpetuating the family lineage. The high prevalence of depression among the respondents in this study could also be due to the fact they are predominantly Muslims and childbearing is considered as very important and valuable in Islam. In the study area, having children stabilizes the family and increases marital satisfaction. Women without at least a child are therefore prone to being treated disrespectfully and stigmatized by the relatives of their husbands who may even encourage the husbands to divorce them or marry another wife since it is permitted by Islamic law (Ramezanzadeh et al., 2004). The significantly higher prevalence of depression among respondents that have been married for ≤ 3 years (43.6%) as compared to those that have been married for longer periods of time in this study could be related to the high expectation of seeing the woman becoming



pregnant as soon as possible after marriage to prove her womanhood, and in situations where the woman is the first and only wife, to prove that her husband is “man enough”. The fear of contending with embarrassing questions from in-laws regarding delay in having a child could therefore exact serious psychological stress on the woman in the early years following marriage. The significantly higher proportion of respondents with negative attitude towards child adoption having depression (79.2%) as compared to those with positive attitude towards it (40.0%) is similar to the finding in a study by Upkong and Orji (2006), and this could be related to the fact that adoption is not widely practiced in this part of the country as compared to other places, thus reflecting the variations in religious beliefs and cultural practices from one place to another. In this study, almost all the respondents with poor support from their in-laws (92.3%) had depression as compared to those with good support. This is in consonance with the finding in a study by Upkong and Orji (2006), and it highlights the substantial influence in-laws have on marital relationships in many developing countries where many families stay together as extended families with their in-laws in a compound, thus facilitating close interactions and show of concern by the members of the respective nuclear families in the group. It is therefore necessary for care providers to promote child adoption among women undergoing fertility treatment, routinely screen them for depression, and also include their extended family members in the interventions for preventing depression among them.

CONCLUSION This study showed high levels of perception of the benefits and consequences of sharing their feelings regarding their infertility with others, and high prevalence of depression among females with infertility in Sokoto, Nigeria. Care providers should promote child adoption among women undergoing fertility treatment, routinely screen them for depression and include their extended family members in the interventions for preventing depression among them. Acknowledgements The authors appreciate the Management of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, for giving the permission to conduct the study. The Head of Department of Obstetrics and Gynecology, UDUTH, Sokoto, Nigeria, the staff of the Gynecological Clinic, and all the patients that participated in the study are also appreciated for their cooperation.

Source of support Nil. Conflict of interest None declared.

REFERENCES Abbey A, Andrews FM, Halrnan LJ (1991). Gender’s role in

response to infertility. Psychology of Women Quarterly 15(2): 295-316.

Abiodun OM, Balogun OR, Fawole AA (2007). Aetiology, clinical features and treatment outcome of intrauterine adhesion in Ilorin, Central Nigeria. West Afr. J. Med. 26(4): 298-301.

Al-Asadi JN, Hussein ZB (2015). Depression among infertile women in Basrah, Iraq: prevalence and risk factors. J. Chi. Med. Assoc. 78(11): 673-7.

Alhassan A, Abaidoo CS (2012). Effect of maternal age on endometrial morphology among Ghanaian infertile women. J. Med. Biomed. Sci. 1(1):9-13.

Andersson L, Sundstrom-Poromaa I, Wulff M, Astrom M, Bixo M (2004). Implications of antenatal depression and anxiety for obstetric outcome. Obstet. Gynecol. 104(3): 467-476.

Andrews FM, Abbey A, Halman LJ (1991). Stress from infertility, marriage factors, and subjective well-being of wives and husbands. J. Health Soc. Behav. 32(3): 238-253.

Baumeister H, Harter M (2007). Prevalence of mental disorders based on general population surveys. Soc. Psychiatry Psychiatr. Epidemiol. 42(7): 537-46.

Beck AT (1978). Beck Depression Inventory. Available at: https://www.ismanet.org/doctoryourspirit/pdf/Beck-Depression-Inventory-BDI.pdf [Last accessed on 2019, March 5].

Caplan G, Mason EA, Kaplan DM (2000). Four studies of crisis in parents of prematures. Community Ment. Health J. 36(1): 25-45.

Dyer SJ, Abrahams N, Mokoena NE, Lombard CJ, van der Spuy ZM (2005). Psychological distress among women suffering from couple infertility in South Africa: a quantitative assessment. Hum. Reprod. 20(7) 1938-43.

Gerrits T (1997). Social and cultural aspect of infertility in Mozambique. Patient Educ. Couns. 31(1): 39-48.

Greil AL (1997). Infertility and psychological distress: a critical review of the literature. Soc. Sci. Med. 45(11): 1679-704.

Ibrahim T (2009). Research Methodology and Dissertation Writing for Health and Allied Health Professionals. Abuja, Nigeria: Cress Global Link Limited.

Idrisa A, Ojiyi E, Tomfati O, Kamara TB, Pindiga HU (2001). Male contribution to infertility in Maiduguri, Nigeria. Trop. J. Obstet. Gynaecol. 18(2): 87-90.

Isawumi AI (2011). Management of Infertility: a broad overview. IFEMED. In: Abiodun OM, Balogun OR, Fawole AA (2007). Aetiology, clinical features and treatment outcome of intrauterine adhesion in Ilorin, Central Nigeria. West Afr. J. Med. 26(4): 298-301.

https://www.ismanet.org/doctoryourspirit/pdf/Beck-Depression-Inventory-BDI.pdf

https://www.ismanet.org/doctoryourspirit/pdf/Beck-Depression-Inventory-BDI.pdf



Kendler KS, Thornton LM, Gardner CO (2000). Stressful life

events and previous episodes in the etiology of major depression in women: an evaluation of the "kindling" hypothesis. Am. J. Psychiatry 157(8) 1243-51.

King RB (2003). Subfecundity and anxiety in a nationally representative sample. Soc. Sci. Med. 56(4): 739-51.

Ljubin-Sternak S, Mestrovic T (2014). Clamydia trachomatis and genital Mycoplasmas: pathogens with an impact on human reproductive health. J. Pathog. 2014; 183167.

Maheshwari A, Hamilton M, Bhattacharya S (2008). Effect of female age on the diagnostic categories of infertility. Hum Reprod. Update 23(3): 538–542.

Makar RS, Toth TL (2002). The evaluation of infertility. Am. J. Clin. Pathol. 117 Suppl: S95-103.

Masoumi SZ, Pooralajal J, Keramat A, Moosavi SA (2013). Prevalence of depression among infertile couples in Iran: a meta-analysis study. Iranian J. Public Health 42 (5): 458-466.

Matsubayashi H, Hosaka T, Izumi S, Suzuki T, Kondo A, Makino T (2004). Increased depression and anxiety in infertile Japanese women resulting from lack of husband’s support and feelings of stress. Gen. Hosp. Psychiatry 26(5): 398-404.

Monga M, Alexandrescu B, Katz SE, Stein M, Ganiats T (2004). Impact of infertility on quality of life, marital adjustment, and sexual function. Urology 63(1): 126-30.

Morin-Davy, L (1998). Infertility: a couples lived experiences of hope and spirit. Dissertation Abstracts International 58:4462.

Okonofua FE (2005). Female and Male Infertility in Nigeria. Stockholm, Sweden: Karolinka University Press.

Olive K, Sekar KP, Susila C (2014). Level of anxiety among women with infertility problems, at Pondicherry city hospital, Puducherry – A Descriptive study. Int. J. Compreh. Nurs. 1(1): 48-51.

Orji EO, Kuti O, Fasubaa OB (2002). Impact of infertility on

marital life in Nigeria. Int. J. Gynecol. Obstet. 79(1): 61-2. Panti AA, Sununu YT (2014). The profile of infertility in a

teaching Hospital in North West Nigeria. Sahel Med. J. 17(1): 7-11.

Ramezanzadeh F, Aghssa MM, Abedinia N, Zayeri F, Khanafshar N, Shariat M, Jafarabadi M (2004): A survey of relationship between anxiety, depression and duration of infertility. BMC Womens Health 4: 9.

Robinson GE, Stewart DE (1996). The psychological impact of infertility and new reproductive technologies. Harv. Rev. Psychiatry 4(3): 168-72.

Sami N, Ali TS (2006). Psychosocial consequences of secondary infertility in Karachi. J Pak. Med. Assoc. 56(1): 19-22.

Statistics Sweden (2007). Official Statistics of Sweden. Available at: https://www.mdgs.un.org/unsd/statcom_seminar?sweden.pdf [Last accessed on 2019 March 4].

Ulbrich PM, Coyle AT, Llabre MM (1990). Involuntary childlessness and marital adjustment: his and hers. J. Sex Marital Ther. 16(3): 147-58.

Upkong D, Orji E (2006). Mental health of infertile women in Nigeria. Turk Psikiyatri Derg. 17(4): 259-65.

Volgsten H, Svanberg AS, Ekselius L, Lundkvist O, Poromaa IS (2008). Prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment. Hum Reprod. 23(9): 2056-2063.

Williams KE, Zappert LN (2006). Psychopathology and psychopharmacology in the infertile patient. In: Covington SN, Burns L (Eds). Infertility Counseling. NY, USA: Cambridge University Press.

World Health Organization (WHO) (2010): Mother or nothing: The agony of infertility. Bull. World Health Organ 88(12): 881-882.

How to cite this article: Isah MB, Oche MO, Yunusa EU, Yunusa MA, Oladigbolu RA, Arisegi SA (2019). Perception, prevalence and correlates of depression among females attending the Gynaecological Clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Int. Arch. Med. Med. Sci. 1(2): 29-35.

https://www.mdgs.un.org/unsd/statcom_seminar?sweden.pdf

https://www.mdgs.un.org/unsd/statcom_seminar?sweden.pdf

` Falaki et al.: Family functionality among elderly patients with chronic illnesses


Family functionality among elderly patients with chronic illnesses attending the General Outpatient Clinic of Usmanu Danfodiyo

University Teaching Hospital, Sokoto, Nigeria

Fatima A. Falaki1*

, Bukar A. Grema2, Sanjay Singh

1, Ridwan M. Jega

3,

Abubakar Kaoje1, Sarafadeen A. Arisegi

1

1Department of Family Medicine,

3Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto,

Nigeria, 2Department of Family Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria

Background: Chronic illnesses are the leading cause of deaths worldwide. Although, the global epidemics of chronic illnesses have been strongly linked to population ageing, elderly patients with functional families are known to have better chances of survival and better ability to recover from illness. This study was conducted to assess family functionality among elderly patients with chronic illnesses attending the General Outpatient Clinic of Usmanu Danfodiyo University, Sokoto, Nigeria. Materials and Methods: This was a cross-sectional study among 372 elderly patients selected by systematic sampling technique. A structured interviewer-administered questionnaire was used to collect data on the research variables. Data were analyzed using IBM SPSS version 20 statistical computer software package. Results: The mean age of the respondents was 69.7 ± 8.7 years, majority of them were females (52.4%), had no formal education (60.2%), and close to half of them (47.9%) earn <N235/day/head. Although, most of them lived with other family members (92.5%) in an extended family structure (77.4%), only about half of them (53.2%) had family support, while about two-thirds (59.0%) perceived their respective families to be functional. Perception of having a functional family was significantly associated (p<0.05) with being female, being a Muslim, living in extended family structure, having formal education, being employed, having family support and living with other family members. Conclusion: These findings underscore the need for family physicians to involve family members in the care of the elderly to promote family functionality, and make advocacy to government for provision of free health and other welfare services for the elderly.

Keywords: Family functionality, elderly patients, chronic illnesses

INTRODUCTION Globally, humans now live longer particularly in Asia and Europe where many countries have predominantly ageing demographic profiles (Prince et al., 2015; Rechel et al., 2013). In Beijing, China, the elderly constituted 16.9% of the total population in 2006 and this is expected to reach 30% in 2025 (Cheng et al., 2011). In the UK, over 15 million people were aged ≥ 60 years, with 1.5 million of these being aged ≥ 85 years, and it is expected to surpass 20 million by 2030 (Rachel et al., 2013). This changing demographics has also been reported in the United States, where 35 million (12.4%) of its populace were aged ≥ 65 years, with a projection of reaching 71.5 million by 2030 (Holtzman and Anderson, 2012). Studies in developing countries also

reported a similar rising trend of the elderly population (Prince et al., 2015). An estimated 63.0% of the population aged ≥ 60 years currently live in developing countries and this is expected to increase by 10.0% over the next 25 years (Boerma and Mathers, 2015). As the most populous country in Africa, Nigeria currently has the highest number of aged or elderly people in Africa (Gesinde et al., 2011). In Nigeria, current estimates indicate that the elderly constitute 6% of the population and the number of individuals aged ≥ 60 years is projected to be 16 million by 2030 and 47 million by the year 2060 (United Nations, 2012). Chronic illnesses (defined as diseases or disabilities that last six 36 International Archives of Medicine and Medical Sciences І March – April 2019 І Volume 1 І Issue 2

ABSTRACT


Original Article


*Corresponding Author: Dr. Fatima A. Falaki, Department of Family Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto,

Nigeria. E-mail: [email protected]





months or longer, or experience of long-term bodily or health disturbance) are the leading cause of deaths worldwide (Martin, 2007; Strath et al., 2012). Across the globe, epidemics of chronic illnesses are strongly linked to population ageing and 23% of total global burden of disease is attributable to disorders in people aged 60 years and older (Prince et al., 2015). Diagnosis of chronic illness in older age groups is associated with loss of self-esteem from social isolation, and the loss of privacy over personal bodily functions (Thompson, 2009). Furthermore, those suffering from chronic illnesses must adjust to the stress of treatment, symptoms of the disease, financial burden of their illness, changes in family structure, and feelings of vulnerability and loss of control (Thompson, 2009). Chronic illnesses in elderly patients may drastically affect family dynamics because they have significant impact not only on the development of the individual suffering from it, but also on the individual's family members and relationships (Rosland et al., 2012). The family is the most intimate current and past social environment of an individual and has a powerful influence on the health beliefs and behaviors, as well as the overall mental and physical health of the individual (Rosland et al., 2012). The dynamic relationships in families to some extent interfere in the process of health and illness of its members, as well as interpretation of illness experience of each member of the family (Santos et al., 2012). Family-care remains the most widely used survival strategy for the majority of the world’s older people, whether in the context of extended families or co-residence of parents with adult children (Botha and Booysen, 2014).

Traditionally, in Nigeria, the extended family system has cared for the Nigerian elderly and it has been shown that the family still accounts for a large proportion of the support they receive (Okumagba, 2011). Thus, most aged persons expect support from their relatives and friends but most especially from their children. As a result of this, the desire for elderly age security from children was one of the motivations for large family sizes in Nigeria (Shofoyeke and Amosun, 2014). However, because of the declining economy, unemployment, underemployment and inflation among others, many children are no longer in a position to provide care and support for their aged parents and relatives while the family support networks are on the decline (Okumagba, 2011). In rural sub-Saharan African countries, urbanization has also broken down the traditional sense of family responsibility as it often leads to young people being separated from their grandparents who had

previously played special roles in their traditional education and socialization (Shofoyeke and Amosun, 2014). In addition, unlike the economically developed countries, lack of social security schemes has worsened the predicaments of the elderly across the continent (Okumagba, 2011).

The functional family system is the group that responds to conflicts and critical situations in order to get emotional stability and seek appropriate solutions through its own resources (Santos et al., 2012). In functional families, members harmonize their own obligations towards others in an integrated, functional and effective form thereby protecting the integrity of the system as a whole (Santos et al., 2012). The social support inherent in a functional family allows for the reduction of vulnerability to stressful events such as chronic illnesses in the elderly population (Wang and Zhao, 2012). In South Africa, Botha and Booysen (2014) studied family functioning and life satisfaction and happiness using data from the 2011 South African Social Attitudes Survey and showed that an improved level of family functioning was positively associated with life satisfaction and happiness.

Dysfunctional family systems on the other hand are those in which there is no commitment to the dynamics and system maintenance by its members (Smith et al., 2012). Dysfunctional families prioritizes their private interests at the expense of the group, thus family members fail to assume their roles within the system (Smith et al., 2012). This often results in conflicts, misbehavior, reduced parental monitoring and management of children’s behavior, neglect or abuse of vulnerable members of the group; and they occur frequently, thus making other family members to accommodate such actions (Inem, 2016).

Santos et al. (2012) observed dysfunctional families to have limited ability in providing adequate care relative to the needs of their elderly members with chronic illnesses, while the elderly with functional families have better chances of survival and better ability to recover from illness. Evidently, the importance of the family and family functionality on physical and psychological health of individuals especially the vulnerable such as the elderly cannot be overemphasized (Inem, 2016). It is therefore essential to study the family functionality of elderly patients with chronic illnesses as the knowledge gained from this study will help provide some insight and guide family physicians in reinforcing and restoring family relationships, and in improving the quality of care provided to chronically ill patients and their families.

Falaki et al.: Family functionality among elderly patients with chronic illnesses


This study was conducted to assess family functionality among elderly patients with chronic illnesses attending the General Outpatient Clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.

MATERIALS AND METHODS Study Design, Population and Area, Sample Size Determination and Sampling Technique A cross-sectional study was conducted among elderly patients with chronic non-communicable diseases attending the General Out-patient Clinic of the Department of Family Medicine, Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria, between July and September 2016. The hospital is a 700-bed tertiary health facility that provides primary, secondary and tertiary care to the inhabitants of Sokoto state, the neighboring states of Kebbi, Zamfara, Katsina, and some parts of neighboring Niger republic. All patients aged ≥60 years presenting with any of the chronic non-communicable diseases, whether single or multiple [of at least six months duration and was within the ICPC-2-PLUS classification (WONCA International Classification Committee, 1998)], or had been on treatment for at least three months were considered eligible for enrollment into the study. Those with disease exacerbation or clinically unstable patients (e.g., flaring osteoarthritis and congestive cardiac failure, as they may require emergency services), those with dementia and other disabling mental illness, and those with hearing impairment or language difficulties without an accompanying person were excluded. The sample size was statistically estimated at 372 and the eligible participants were selected by systematic sampling technique (one of two patients presenting consecutively at the clinic that meets the eligibility criteria and gave informed consent to participate in the study was selected over a period of 2 months until the required sample size was obtained). Data Collection and Analysis A structured pretested interviewer-administered questionnaire was used to obtain information on the respondents’ socio-demographic characteristics, family characteristics and family APGAR scores. Family APGAR is a scale that was developed by Smilkstein in 1978 (Muyibi et al., 2010), and it consisted of questions that allowed for the quantifying of the perception that the individuals have of their family functionality. These questions allow for the assessment of the individual’s satisfaction with their family functioning, based on some elements considered to be essential in the family unit, according to the acronym APGAR. These elements

comprised adaptability (i.e., the sharing of resources, as well as the degree of satisfaction with the attention received), participation (i.e., joint decision-making and family communication when solving problems), growth (i.e., the realization of emotional growth due to freedom within the family to change roles), affection (i.e., the individual’s satisfaction regarding intimacy between family members and the family interactions) and resolution (i.e., the sharing of time and satisfaction with the commitments that family members establish). The APGAR questionnaire consists of five questions regarding the components of family function, with three possible answers presented in a Likert-type scale of three points (“almost always”, “sometimes”, “almost never”) the score varies between zero and two points. The sum can be zero to ten points and families can be characterized as: a functional family (7-10) or moderately dysfunctional family (<6) and severely dysfunctional (≤ 2) (Muyibi et al., 2010). Previous studies have identified the family APGAR scale as the best tool for measuring family functionality in individuals, and analysis of its psychometric properties also found it to be valid and reliable for population screening (Takeneka and Ban, 2016; Da Silva et al., 2014). Data were analyzed using IBM Statistical Package for the Social Sciences (SPSS) version 20.0 software. Quantitative variables were summarized using mean and standard deviation, while qualitative variables were summarized using frequencies and percentages. Frequency distribution tables were constructed; and cross tabulations were done to examine the relationship between categorical variables. The Pearson’s Chi-square test was used to compare differences between proportions. All levels of significance were set at p < 0.05. Ethical Consideration Institutional ethical clearance was obtained from the Ethical Committee of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Permission to conduct the study was obtained from the Management of the hospital, and informed consent was obtained from the participants before administering the questionnaires.

RESULTS Socio-demographic characteristics of respondents All the 372 questionnaires administered were adequately completed and found suitable for analysis, giving a response rate of 100%. The ages of the respondents ranged from 60 to 102 years (mean = 69.7 ± 8.7years),



with a larger proportion (34.7%) in the 60-64 years age group. Majority of respondents were females (52.4%), practiced Islam as religion (87.1%), and were Hausa by tribe (68.0%). Close to two-thirds of respondents (60.2%) had no formal education, about half (54.8%) were unemployed, and close to half of them (47.9%) earn less than N235/day/head. Majority of respondents were married (71.0%) and were in multiple households (76.6%) and extended family (77.4%) types of relationship (Table 1). Respondents’ family characteristics Only about half, 198 (53.2%) of the 372 respondents received support from their spouses, children, grandchildren, or other relatives and friends. Most of the respondents (92.5%) lived with other family members, and with majority of them (66.1%) being in a family size of 5 or more (Table 2). Respondents’ perception of family functionality and associated factors Majority of respondents (59.0%) perceived their respective families as being functional (Figure 1). The proportion of respondents that perceived their respective families to be functional was significantly higher (p < 0.05) among males (58.8%) as compared to females (47.5%); among Muslims (62.0%) as compared to Christians (36.4%) and those who practiced traditional religion (25.0%); and among those in extended family settings (60.1%) as compared to those in nuclear family settings (48.8%). Likewise, the proportion of respondents that perceived their respective families to be functional was significantly higher (p < 0.05) among those with formal education (62.2%) as compared to those without (40.2%); among those that were employed (67.9%) as compared to those that were unemployed (13.2%); among those with family support (69.2%) as compared to those without (46.6%); and among those who live with other family members (61.1%) as compared to those who live alone (28.6%). There was no association (p > 0.05) between functional family status and type of marriage (i.e., monogamous and polygamous), and family size (Table 3).

Table 2: Respondents’ family characteristics


Had family support

Yes 198 (53.2) No 174 (46.8)

Living arrangement Alone 28 (7.5) With other family members 344 (92.5)

Family size <5 126 (33.9) ≥5 246 (66.1)

Table 1: Socio-demographic characteristics of respondents


Age group (years)

60-64 129 (34.7) 65-69 96 (25.8) 70-74 50 (13.4) 75-79 41 (11.0) 80-84 22 (5.9) >85 34 (9.2)

Sex Male 177 (47.6) Female 195 (52.4)

Religion

Islam 324 (87.1) Christianity 44 (11.8) Traditional 4 (1.1)

Ethnicity

Hausa 253 (68.0) Igbo 72 (19.4) Yoruba 35 (9.4) Others 12 (3.2)

Marital status

Not married 108 (29.0) Married 264 (71.0)

Household type

Single 87 (23.4) Multiple 285 (76.6)

Family type

Nuclear 84 (22.6) Extended 288 (77.4)

Education

Non-formal 224 (60.2) Formal 148 (39.8)

Occupational status

Employed 168 (45.2) Unemployed 204 (54.8)

Income (Naira)

<235/day/head 178 (47.9) ≥235/day/head 194 (52.1)

Figure 1: Respondents’ perception of family functionality



Table 3: Factors associated with family functionality among respondents

Variables Family functionality status Test of significance

Functional

Frequency (%)

Dysfunctional

Frequency (%)

Sex

Male 90 (58.8)* 63 (41.2) 2= 35.152, p < 0.001 Female 104 (47.5) 115 (52.5)

Religion Islam 201 (62.0)* 123 (38.0)

2= 50.214, p < 0.001 Christianity 16 (36.4) 28 (63.6)

Traditional 1 (25.0) 3 (75.0)

Type of marriage Monogamous 91 (54.5) 76 (45.5)

2= 3.302, p = 0.497 Polygamous 123 (62.0) 77 (38.0)

Household type Nuclear 41 (48.8) 43 (51.2)

2= 30.322, p < 0.001 Extended 173 (60.1)* 112 (38.9)

Education

2= 26.482, p < 0.001

Non-formal 90 (40.2) 134 (59.8) Formal 92 (62.2)* 56 (37.8)

Occupation Employed 114 (67.9)* 54 (32.1)

2= 26.015, p < 0.001 Unemployed 27 (13.2) 177 (86.8)

Had family support

2= 64.189, p < 0.001

Yes 137 (69.2)* 61 (30.8) No 81 (46.6) 93 (53.4)

Living arrangement

2= 47.967, p < 0.001

Alone 8 (28.6) 20 (70.1) With other family members 210 (61.1)* 134 (38.9)

Family size <5 66 (52.4) 60 (47.6)

2= 6.582, p = 0.189 ≥5 153 (62.2) 93 (37.8)

*Statistically significant (p < 0.05)

DISCUSSION This study assessed family functionality among elderly patients with chronic illnesses attending the General Outpatient Clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. The findings from this study indicate that a larger proportion of respondents were in the age bracket 60-64 years, an observation that is in consonance with the Nigerian National Demographic Health Survey 2013 wherein two-thirds of the elderly belong to the same age bracket (NPC and ICF Int., 2014). The importance of this, is that this cohort of “active elderly” individuals (i.e. 60-64 years) can be targeted for early preventive interventions, which if instituted early may lead to successful ageing (characterized by an improvement in the quality of life and reduction in illness and death in the elderly) (Omotara et al., 2015). There was a predominance of females among the elderly interviewed in this study. Females constituted more than half (52.4%) of the respondents. This is similar to the findings of Adebusoye et al. (2011) in a cross-sectional study conducted to determine the morbidity patterns

among elderly patients in the general outpatient clinic of a tertiary hospital in south-western Nigeria in which 62.2% of the respondents were females. These findings may be attributed to the current global phenomenon described as “feminization of old age” (Vera et al., 2015) whereby there is predominance of women in the elderly population probably as a result of their longer life expectancy. This phenomenon is a two-edged sword; on the one hand it implies a reduction of deaths in women, yet on the other hand, as a result of the longevity, it signals a period of social isolation and frequently, economic adversity in them (Vega et al., 2015). Regarding the educational level of the respondents in this study, about two-thirds (60.2%) received no formal education. A study on assessment of determinants of healthy ageing among the rural elderly in Maiduguri, north-eastern Nigeria by Omotara et al (2015) reported that 73.6% of the study participants had no formal education. Consistent with the aforementioned studies is the finding in a study to determine the morbidity patterns among community dwelling elderly in Zaria,



north-western Nigeria, by Yusuf et al. (2011) which found that most (91.0%) of the elderly respondents had no formal education. Given that evidence exists on the positive effects of formal education on improving health related knowledge, problem solving abilities, accessibility to preventive health services and self-management of chronic illnesses, the poor uptake of formal education among the respondents in the other studies and the current study may translate to poor health indices in these areas (NPC and ICF Int. 2014). In contrast, a study conducted in Ghana by Ayernor et al. (2012) reported that only 35.8% of respondents had no formal education. The difference between this study and the latter study may be due to the age range of 50-59 years included by Ayernor and colleagues, whereas in this study and the others studies included respondents that were aged ≥60 years. The employment status of elderly respondents in this study showed that more than half of them (54.8%) were unemployed. In contrast, a survey by Shofoyoke and Amosun (2014) on care and support for the elderly carried out in four geopolitical zones of Nigeria (south-south, south-east, south-west and north-central) found that over half (51.7%) of the elderly respondents were employed. In our study setting located in north-western Nigeria, there exists a socio-culturally assigned gender role in which males serve as the main income earners (NPC and ICF Int., 2014). A total of 77.4% of respondents in the current study were in an extended family structure. This is in consonance with the findings by Okumagba (2011) in Delta state, south-south Nigeria, and it supports the submission that the family unit in these areas most likely provide a large proportion of the support most aged persons receive. In the present study, majority of the elderly were found to reside with their families. Similarly, Omotara et al (2015), reported multi-generational households as being more common in Maiduguri, north-eastern Nigeria. On the contrary, in a survey to assess the care and support given to the elderly in Nigeria, Shofoyoke et al. (2014), observed a predominance of elderly persons living alone in Lagos city, located in the south-western part of Nigeria. Thus, there is a varied dynamics of living arrangement as observed in the studies above, and this may be explained by the polygamous types of marriage and the existing extended family structure in most parts of northern Nigeria (Omotara et al., 2015). Such type of marriage leads to high fecundity and hence more

likelihood of the elderly living with their children in later life in such areas. The environment in which we live is one of the most influential factors on our lives. For older people, this may be particularly so since they spend more time at home than many other groups in the society. Living alone without help leads to a poor self-rated health and high levels of disability and depression in the elderly (who are also more vulnerable to chronic illnesses) (Okumagba, 2011; Bolina and Tavares, 2016). Almost half (46.8%) of the respondents in this study supported themselves. In contrast, other studies (Okumagba, 2011; Omotara et al., 2015) have found that family support for the elderly is mainly provided by others. To explain this, it must be considered that in this study, a larger proportion of respondents were found to be of the age bracket 60-64 years. This cohort of elderly are termed “active elderly” given that they still retain most of their physical and mental capabilities, and as such, can support themselves (Omotara et al., 2015). In the present study, close to two-thirds of the respondents (59.0%) perceived their families to be functional. In consonance, Da Silva et al. (2014) in Brazil studied a cohort of elderly patients in order to determine their family functionality, and reported that majority of respondents (81.6%) perceived their families to be functional. In contrast, however, Chaves et al. (2013) assessed the family function of the elderly with chronic illness in Viseu, Portugal, and found that most (81.3%) of the respondents perceived their families to be dysfunctional. The observed difference in family functionality may be due to racial dissimilarities, and differences in culture, sample sizes, and the methodology used. The current study and the Brazilian study by Da Silva et al. (2014) had sample sizes of 372 and 400 respondents respectively and both studies used probability sampling methods to select respondents, whereas the study in Portugal by Chaves et al. (2013) had a sample size of 294 respondents selected by non-probability (convenience) sampling method which is known to be hampered by selection bias. About two-thirds (60.1%) of the elderly respondents who were living in an extended family setting in this study regarded their families as being functional, as compared to less than half (48.8%) of those from nuclear family settings. This finding highlights the importance of accommodating the elderly in the extended family structure as it enables the family members to become aware of their needs and render the necessary assistance to them promptly. Family support is



a major concern in the elderly as they are more prone to developing medical problems such as chronic illnesses which require constant care and supervision. Elderly people mostly rely on their family members for assistance on social problems like limited economic resources and depleted social networks (Okumagba, 2011). Such a support was observed among 69.2% of the elderly who perceived their family as being functional in this study. The findings of this study therefore underscore the need for family physicians to sensitize the public on the benefits of retaining the traditional extended family structure, involve family members in the care of the elderly to promote family functionality, and make advocacy to government for provision of free health and other welfare services for the elderly.

CONCLUSION The poor educational attainments, low income and sub-optimal levels of family support and perception of family functionality among the respondents in this study despite the fact that most of them live with their family members underscore the need for family physicians to involve family members in the care of the elderly to promote family functionality, and make advocacy to government for provision of free health and other welfare services for the elderly. Acknowledgements The authors appreciate the Management of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, for giving the permission to conduct the study. The Head of Department of Family Medicine, UDUTH, Sokoto, Nigeria, the staff of the General Outpatient Clinic, and all the patients that participated in the study are also appreciated for their cooperation. Source of support Nil. Conflict of interest None declared.

REFERENCES Adebusoye LA, Ladipo MM, Owoaje ET, Ogunbode AM

(2011). Morbidity pattern amongst elderly patients presenting at a primary care clinic in Nigeria. Afr. J. Prm. Health Care. Fam. Med. 3(1): 211.

Ayernor PK (2012). Diseases of Ageing in Ghana. Ghana Med. J. 46(2 Suppl): 18-22.

Boerma T, Mathers CD (2015). The World Health Organisation and global health estimates: improving collaboration and capacity. BMC Med. 13: 50.

Bolina AF, Tavares DM (2016). Living arrangements of the

elderly and the socio demographic and health determinants: a longitudinal study. Revista Latino-Americana de Enfermagem 24: e2737.

Botha F, Booysen F (2014). Family functioning and life satisfaction and happiness in South African households. Soc. Indic. Res. 119(1): 163-82.

Chaves CB, Amaral OP, Nelas PA, Coutinho EC, Dionisio RM (2013). Assessment of family functionality among the elderly with chronic illness. Eur. J. Couns. Psych. 2(2): 139-44.

Cheng Y RM, Wang W, Yang L, Li H (2011). Population ageing and residential care resources in Beijing: spatial distribution of the elderly population and residential care facilities. Asian J. Gerontol. Geriatr. 6(1): 14-21.

Da Silva MJ, Victor JF, Mota FRN, Soares ES, Leite BMB, Oliveira ET (2014). Psychometric analysis of family APGAR. Esc. Anna Nery 18(3): 527-32.

Gesinde AM, Adekeye OA, Iruonagbe TC (2011). Counselling services for remediating the biopsychosocial challenges of the aged in Nigeria. J. Func. Manage. 3 (1): 89-98.

Holtzman D, Anderson LA (2012). Aging and health in America: a tale from two boomers. Am. J. Public Health 102(3): 392.

Inem V (2016). Foundational knowledge for the practice of family medicine in West Africa, 1st ed. Lagos: Gbola Awujoola Press.

Martin CM (2007). Chronic disease and illness care: adding principles of family medicine to address ongoing health system redesign. Can. Fam. Physician 53(12): 2086-91.

Muyibi AS, Ajayi IOO, Irabor AE, Ladipo MMA (2010). Relationship between adolescents’ family function with socio-demographic characteristics and behaviour risk factors in a primary care facility. Afr. J Prim. Health Care Fam. Med. 2 (1), Art. #177, 6 pages.

National Population Commission (NPC) [Nigeria] and ICF International (2014). Nigeria Demographic and Health Survey 2013. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International.

Okumagba PO (2011). Family support for the elderly in delta state of Nigeria. Stud. Home Comm. Sci. 5(1): 21-27.

Omotara BA, Yahya SJ, Wudiri Z, Amodu MO, Bimba JS, Unyime J (2015). Assessment of the determinants of healthy ageing among the rural elderly of North-Eastern Nigeria. Health 7(6): 754-64.

Prince MJ, Wu F, Guo Y, Gutierrez Robledo LM, O'Donnell M, Sullivan R, Yusuf S (2015) . The burden of disease in older people and implications for health policy and practice. Lancet 385(9967): 549-62.

Rechel B, Grundy E, Robine JM, Cylus J, Mackenbach JP, Knai C, McKee M (2013). Ageing in the European Union. The Lancet 381(9874): 1312-22.

Rosland AM, Heisler M, Piette JD (2012). The impact of family behaviors and communication patterns on chronic illness outcomes: a systematic review. J. Behav. Med. 35(2): 221-39.



Santos AL, Cecilio HPM, Teston EF, Marcon SS (2012).

Knowing the family functionality under the view of a chronically ill Patient. Texto Contexto Enferm 21(4): 879-86.

Shofoyeke AD, Amosun PA (2014). A survey of care and support for the elderly people in Nigeria. Mediterr. J. Social Sci. 5(23): 2553-563.

Smith SM, Soubhi H, Fortin M, Hudon C, O’Dowd T (2012). Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. BMJ 345: e5205.

Strath SJ, Greenwald MJ, Isaacs R, Hart TL, Lenz EK, Dondzila CJ, Swartz AM (2012). Measured and perceived environmental characteristics are related to accelerometer defined physical activity in older adults. Int. J. Behav. Nutr. Phys. Act. 9: 40.

Takenaka H, Ban N (2016). The most important question in family approach: the potential of the resolve item of the family APGAR in family medicine. Asia Pac. Fam. Med. J. 15:3.

Thompson JJ (2009). How chronic iIlness affects family relationships and the individual. Available at:https://pdfs.semanticscholar.org/ [Last accessed on 2016 May 5].

United Nations (2012). World Population Prospects, The 2012

Revision. Monitoring global population trends. New York: United Nations. Available at: http://esa.on.org/unpd/wpp/ [Last accessed on 2016 February 14].

Vera I, Lucchese R, Nakatani AYK, Sadoyama G, Bachion MM, Vila VdSC (2015). Factors associated with family dysfunction among non-institutionalized older people. Texto Contexto Enferm. 24(1): 494-504.

Wang J, Zhao X (2012). Family functioning and social support for older patients with depression in an urban area of Shanghai, China. Arch. Gerontol. Geriatr. 55(3): 574-79.

WONCA International Classification Committee (1998). ICPC-2-PLUS (International Classification of Primary Care). 3rd ed. Oxford: Oxford University Press.

Yusuf AJ, Baiyewu O, Sheikh TL, Shehu AU (2011). Prevalence of dementia and dementia subtypes among community-dwelling elderly people in northern Nigeria. Int. Psychogeriatr. 23(3): 379-86.

How to cite this article: Falaki FA, Grema BA, Singh S, Jega RM, Kaoje AA, Arisegi SA (2019). Family functionality among elderly patients with chronic illnesses attending the General Outpatient Clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Int. Arch. Med. Med. Sci. 1(2): 36-43.

https://pdfs.semanticscholar.org/

http://esa.on.org/unpd/wpp/



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