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Report of Ocean – Anaedo Medical Mission

Cardiovascular risk factors in Oraifite: an Ibo semi-urban Community

Ajuluchukwu JNA (2011)

Project Director: Mr Sam Ajuluchukwu

Technical Director/Stock Controller: Ebele Obimma

Technical Directors:

  • EzumeriVillage: Sir Uzo Ufondu;Ven. Daniel Okoye
  • IfiteVillage: Jerry Okwuosa; Dr. Jayne N Ajuluchukwu;

Dr. Johnny Chukwuka; Dr. Chukwujekwu

  • IrefiVillage: Dr. Iwu Udechukwu; Dr. G. Okeke
  • UnoduVillage: Dr. Ben Odukwe; Alex Anameje; Dr. Onyeka Anemeje; Dr Benji Odukwe

This report summarises three main aspects of the medical mission: (a) the preparation/pre-mission phase, (b) the mission proper and (c) the results/ outcome.

Introduction: The OCEAN-ANAEDO, is a NGO, comprising of indigenes of Oraifite in Anambra State-Nigeria, living abroad and in Nigeria. The thread holding the group together is their vision of improvement in the health and education of their “home-based relatives”. The OCEAN-ANAEDO medical mission of December 2010 was the initial take-off project to unveil their plans to the local community and potential beneficiaries. More importantly, the medical mission provided a fact – finding opportunity for needed baseline data for a longer –term health package. Oraifite is a semi-urban town; divided into four villages of Ezumeri, Ifite, Irefi, and Unodu. It is in Ekwusigo LGA of AnambraState of Nigeria and is approximately 15 kilometers to Onitsha and 30 kilometers to Awka-the state capital.

Medical authorities, including World health Organisation (WHO), have recognised the potential of NGOs for improving the health status of different communities, regarding awareness, early detection, and in the provision of treatment or intervention (WHO, comm., ssa). In Africa in general, and specifically in Nigeria, there is a spiralling of the twin burdens of emerging Non-Communicable Diseases (NCDs,); as well as the ever-present unfinished agenda of infections. Cardiovascular diseases (CVDs); which are examples of NCDs, usually appear symptomless, early in the disease. Thus, many afflicted individuals may initially be unaware of such health problems or their contributory risk factors. These considerations provided the impetus for the medical mission. NGOs have traditionally had a long history in the Nigerian health landscape.

Therefore, the medical mission code-named OCEAN-ANAEDO 2010 had several aims of (a) providing a cardiovascular disease -directed health-awareness program; (b) provision of therapy for designated diseases (such as malaria, hypertension, diabetes (c) and screening for CVD and risk factors in the Oraifite community (d) generation of useful community health data for future planning.

SUMMARY OF RESULTS

At the four wards, an average of 200 participants was seen at each ward daily, thus more than 5,000 subjects benefited from the medical mission. However, data for CVD data-base were from individuals aged > 15 years. Their total number was 3100; consisting of 1008 males and 2092 females, with an age-range of 15-107 and a mean of 55 years.

Respondents’ self-reported medical issues of note were as follows:

  1. hypertension (high blood pressure: 899=29%
  2. Diabetes: 279=9%
  3. Dyspepsia/peptic ulcer: 558= 18%.
  4. Others were ~1% each: Seizures/epilepsy 30; asthma 35; and sickle cell disease 46.

Risk behaviour:

Excessive salt or by use of table salt: 31%=961

Alcohol: 34%=1054 in any quantity

Tobacco use: 383 =12%

Smoking -Cigarettes 372 =36% 0f the males.

Tobacco “nasal Snuff”: 11=2% of smokers

  • Overall, mean systolic blood pressure was 140.2 (SD 29.5) mm Hg. Abnormal systolic blood pressure (SBP) was noted in 1481 (47.8%). This proportion is higher than the national average.
  • Overall mean diastolic blood pressure (DBP) was 80.2 (SD 15.6) mm Hg. One quarter (25.2%) of the group (781) had abnormal diastolic blood pressure. Also higher than the national average.
  • Average SBP of females and males were comparable (140.45 ±29.58 versus 139.65 ±28.77; p=0.7) mm Hg.
  • Average DBP of females and males were similar (80.14 ±15.65 versus 80.22 ±15.56; p=0.95mm Hg)
  • Using body mass index showed that under-weight status was noted in 387 (12%)
  • Only 38.3% had normal BMI of 20-25 Kg/m2.
  • Overweight status was observed in 961 (31%); and (18%) 558 were overtly obese, respectively.
  • Females had significantly higher BMI than males (25.9 ±5.2 versus 24.6 ±5.2. (p<0.05)
  • Average random blood sugar was 105 mg per dl.

METHODS:

Support Committees: Several committees supervised different aspects of the mission before the take-off, such as- community immersion, communication with elders, community leaders, and Government functionaries. They also obtained permission from the State ministry of health, and provided venues, publicity, transport, refreshments etc. They developed a data – base of indigenous (Oraifite-born) health-care professionals, who were informed of the mission and proffered invitation to participate.

Medical team consisted of a general mission coordinator, and ward coordinators for the four village wards, indigenous health – care professionals, Resident doctors from the Nnamdi Azikiwe Teaching Hospital, Nnewi, and Student Nurses of Iyienu School of Nursing, Onitsha. Other volunteers were the Principal and staff of the Girls’ Secondary school.

Central briefing meetings were held before the mission takeoff for methodology and protocol. Specific sub-committee function of Nigerian-based OCEAN-ANAEDO members were:

  • compilation of the names, addresses, and emails of indigenous HCPs hailing from the Oraifite community, and inviting them to participate in the community program by volunteering their skills
  • Invitation of a cardiologist and other physicians, to participate and follow up newly diagnosed patients
  • Invitation of Resident doctors from the Teaching Hospital to participate in the treatment phase
  • Invitation of Nurses from the State Training Nursing Institute of IyienuHospital, Anambra
  • Sourcing and procurement of materials needed for the screening and treatment phases of the medical mission such as sphygmomanometers, glucometers, cotton wool, syringes, etc
  • Strategic meetings for ward-coordinators
  • Involvement of community leaders, who took care of communication to beneficiaries, selection of adequate sites for the different wards, provision of refreshments etc
  • Invitation of partners, such as Pharmaceutical companies to donate materials and medications for the medial mission
  • Invitation to and permission from the Governor of the State via the Ministry of Health for partnering and participation.

Medical mission consisted of a 4-day community immersion program for the following:

  1. Data acquisition by interviewer-administered questionnaire
  2. Medical screening program,
  3. One day special clinic for Dental and eye problems.
  4. Referrals to identified healthcare professionals in the GeneralHospital or the Teaching Hospital.
  5. Town-hall health awareness lectures, using the local dialect/language, with public address system directed to the market place.
  6. On-site treatment of selected/minor ailments
  7. Deworming of children aged 2 years and 10 years.
  8. Provision of take-home health record card for subsequent health-care and follow-up.

Requirements:

Sphygmomanometers

glucometers

Plastic tape measure

Gloves, syringes, needles/lances,

Scales

Drugs and medications: Anti-malarial agents, multivitamins, pain-killers, anti-hypertensives, oral hypoglycaemic agents, etc

Figure 1:

Legend for Figure 1. Ht=height, Wt=weight, BMI=body mass index,; BP=bllod pressure; AG=abdominal girth, WHR=waist-hip ratio

Figure 1. highlights the flow chart for the mission participants, detailing participant movement, and Mission activities, which included: (a) Registration (b) data acquisition via interviewer – administered questionnaire to provide some baseline health information, etc. Information requested for were age, sex, known medical profile, social history, life – style risk factors etc.

Screening: measurements obtained were height in cm, weight in Kg, abdominal girth, calculation of body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and random blood glucose.

Doctors were available for consultations, and where appropriate, treatment was given. Free medications were also provided for designated patient groups: previously known/diagnosed hypertension, diabetes, asthma and arthritis.

Participants:

Information for CVD data – base building was obtained from adults aged ≥15 years at designated venues from 20th - 24th of December 2010. The contact time was from 9am to 4 pm. Daily program included registration, listening to a short health talk, response to interviewer – administered questionnaire on personal history, risk factors and life-style, mission measurements. Participants were finally given duly completed health cards, as a health record for later use. Resident doctors provided one-on-one interpretation of obtained data; followed by appropriate immediate intervention, which included advice, counselling referral, or on-site treatment.

Weight was obtained to nearest 0.1 Kg, using validated bathroom scales; [using known weights0; and height was measured to the nearest cm. Body mass index was calculated, using weight and height data. Abdominal girth – measure of central adiposity, was measured using a plastic tape at the umbilical level during quiet respiration. Waist – hip ratio, another measure of central adiposity, was obtained by measurement at the actual waist and hip in cm (Ref). The waist was measured at the mid – way position; between the bottom of the rib cage and the iliac crest; whilst the hip was measured at the widest protrusion of the buttocks.

The seated BP was measured after at least 5 minutes of rest, using a mercury sphygmomanometer or validated digital sphygmomanometers. Cut-off SBP value for hypertension was taken at ≥140 mm hg; whereas abnormal DBP was ≥90 mm Hg.

Random blood glucose was measured with appropriate caution, using a One-Touch glucometer (R) or other brand. Abnormal value was taken as 200 mg per dl. Previously undiagnosed individuals with abnormal blood pressure or random blood sugar were invited for a repeat check the next day.

Table 1. Age Distribution of 3100 adults screened in Oraifite.

Age / Number / %
19-29 / 214 / 6.9
30-39 / 90 / 2.9
40-49 / 487 / 15.7
50-59 / 828 / 26.7
>60 / 1481 / 47.8
Total / 3100 / 100

Proportions of Participants with Multiple Cardiovascular Risk Factors

Legend: Risk factors systolic blood pressure; diastolic blood pressure; random blood glucose;

Obesity=BMI>30 Kg/M 2 ; age >60 years. 57% of participants had no risk factors

However, 43% had one to four different cardiovascular risk factors

Table 2. Sex Distribution of Screened Cardiovascular Disease (CVD) Parameters

GENDER / N% / Mean / SD / P
AGE / M
F / 1008
2092 / 57.5
54.5 / 17.1
15.7 / 0.028
BMI / M
F / 24.6
25.9 / 5.2
5.7 / 0.008
ABD G / M
F / 84.9
86.1 / 12.3
14.6 / 0.31
WHR / M
F / 0.95
0.92 / 0.07
0.06 / 0.015
SBP / M
F / 139.65
140.45 / 28.77
29.58 / 0.7
DBP / M
F / 80.22
80.14 / 15.56
15.65 / 0.95
RBS / M
F / 107.01
105.07 / 34.17
28.70 / 0.57

Legend: M-male, F-female, BMI-body mass index, ABD G=abdominal girth, WHR=waist hip ratio, SBP=systolic blood pressure, DBP=diastolic blood pressure. RBS=random blood sugar

Conclusions:

OEAN-ANAEDO is a mission for the people by their own people. The set objectives were achieved as

(a) Awareness lectures were delivered,

(b) Health education booklets distributed,

(c) Screening for CVD risk factors performed

(d) questionnaire-acquired health information obtained

(e) Successful distribution of health records card

(f) Drugs were also provided as appropriate.

Thus, we have been able to provide a snap-shot view of the health status profile of the community. This will definitely be beneficial in planning for subsequent medical missions or intervention.

Acknowledgements:

  • Governor Peter Obi, Executive Governor of Anambra State, represented by his Commissioner of Health, for endorsing the program; by presenting the Oraifite General Hospital with a brand-new ambulance, at the flag-off ceremony of the mission.
  • The Commissioner of Health of Anambra state for gracing the occasion at the flag-off ceremony
  • Department of Medicine Resident Drs of Nnamdi Azikiwe University Teaching Hospital, Nnewi; who participated in various aspects of the Medical Mission
  • Final Year Medical Students of College of Medicine, NmandiAzikiweUniversity, Nnewi
  • Student Nurses from IyienuHospital for their diligence and cooperation.
  • Staff of the GeneralHospital and the Health Centres in Oraifite
  • Vanguard Newspapers for their support
  • Ranbaxy Laboratories
  • Norvatis Nigeria Ltd
  • Pharmatex Nigeria Ltd
  • Mr Charles Chijide of Charella Nigeria Ltd for Cash Donations
  • Chike Okoli Foundation for their donation of health awareness booklets
  • All non-indigenes of Oraifite who contributed in various ways to ensure the success of the medical mission.
  • Profs. Chris Obionu, Jayne Ajuluchukwu, and Dr John Chukwuka - for well articulated Health Talks.
  • Ven Dan Okoye -- for negotiating the release Iyi-Enu nurses to OCEAN ANAEDO for the Medical Mission
  • Prof Charles Osuji
  • Akunwanne Clinics
  • Dr. Ndubisi Obinegbo , for Drugs Donated
  • Sir Emeka Okwuosa Foundation for Cash and Material donations
  • Mr Tony Nzom for Cash Donations
  • Sir Azuka Okwuosa for Cash Donations
  • Sir Uzo Ufondu for Cash Donations
  • Mr Eugene Anyaba for Cash Donations
  • Chljoke Transport Limited for provision of Transport
  • Chief Sam Okafor for provision of Transport
  • Marshal Ajuluchukwu for provision of Transport
  • Hospitality:
  • EzumeriVillage: ( Ezumeri Meeting) Basil Unuigwe and Executive, Sir Sonny Igoanuzue, Mr Sunday Esione
  • IfiteVillage: (Awor Meeting) Marshall Ajuluchukwu and executive, Chief Sam Okafor – Hospitality of unparalleled magnitude.
  • Irefi Village : Nzuko Irefi, Sir Azuka Okwuosa
  • UnoduVillage : (Isingwu Meeting) Isaac Anachuna and Executive, Dr Ben Odukwe