Indian Journal of Occupational and Environmental Medicine   Official publication of Indian Association of  0ccupational  Health  
 Print this page Email this page   Small font sizeDefault font sizeIncrease font size
 Users Online:736

  IAOH | Subscription | e-Alerts | Feedback | Login 

Home About us Current Issue Archives Search Instructions
  Search
 
  
 
    Similar in PUBMED
     Search Pubmed for
     Search in Google Scholar for
   Related articles
    Article in PDF (324 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


   Abstract
  Introduction
   Participants and...
  Results
  Discussion
  Conclusion
   References
   Article Tables

 Article Access Statistics
    Viewed186    
    Printed2    
    Emailed0    
    PDF Downloaded8    
    Comments [Add]    

Recommend this journal

 


 
  Table of Contents 
ORIGINAL ARTICLE
Year : 2021  |  Volume : 25  |  Issue : 2  |  Page : 101-105
 

Preventive health evaluation in underserved occupational environment: A cross-sectional study of its practice, facilitators, barriers, and benefits among medical practitioners in Nigeria


1 Department of Family Medicine, Federal Medical Centre, Umuahia, Abia State; Department of Medicine, College of Medicine and Health Sciences, Rhema University, Aba, Nigeria
2 Department of Family Medicine, Alex Ekwueme Federal Teaching Hospital Abakiliki; Department of Family Medicine, Alex Ekwueme University, Ndifu Alike, Ebonyi State, Nigeria
3 Department of Family Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi; Department of Family Medicine, Nnamdi Azikiwe University, Awka, Nigeria
4 Department of Health Administraion and Management, University of Nigeria; Department of Health Services, AIICO Multishield Ltd, Enugu, Nigeria

Date of Submission07-May-2020
Date of Decision13-Jun-2020
Date of Acceptance30-Jun-2020
Date of Web Publication9-Jul-2021

Correspondence Address:
Prof. Gabriel Uche Iloh
Department of Family Medicine, Federal Medical Centre, Umuahia, Abia State
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijoem.IJOEM_149_20

Rights and Permissions

 

  Abstract 


Background: The health of medical doctors (MDs) has been the focus of global concern in addition to the recently modified physician oath now called “The Modern Physician Pledge.” As a member of human family, MDs are also prone to diseases they manage in healthcare environment. Objectives: The study was aimed at describing the practice, facilitators, barriers, and benefits of preventive health evaluation (PHE) in a cross-section of medical practitioners in Nigeria. Methodology: A cross-sectional study done on 178 MDs in Nigeria. Data collection was done using pretested, self-administered questionnaire that elicited information on practice, facilitators, barriers, and benefits of PHE. Self-rated health status was also studied. Practice of PHE was inquired in previous one year. Results: The age of the respondents ranged from 25 to 72 (36 ± 10.2) years. There were 161 (90.5%) males. All the respondents were aware of PHE. One hundred and fifty-five (87.1%) respondents rated their overall health then as excellent; 142 (79.8%) rated their overall health compared to 6 months ago as excellent, while 169 (94.9%) rated their overall health compared to others of their age as excellent. Generally, in all ages and both sexes, the most common PHE was blood pressure (BP) measurements (100%). The commonest female sex-specific PHE was self-breast examinations (100%). Among the males, the most common male-specific PHE was testicular self-examinations (87.0%). The commonest facilitator and barrier were family history of hereditary diseases (100%) and financial restraints (82.0%), respectively. The most common benefit was early detection of diseases (100%). Conclusion: Awareness of PHE was 100% but didn't translate to comparative practice orientation. The most common general PHE was BP checks. The commonest female and male sex-specific PHE was self-breast and testicular examinations respectively. The predominant facilitator and barrier were family history of hereditary diseases and financial restraints. The most common benefit was early detection of diseases.


Keywords: Barriers, benefits, facilitators, medical practitioners, Nigeria, preventive health evaluation


How to cite this article:
Iloh GU, Ikwudinma AO, Emeka EA, Obi IV. Preventive health evaluation in underserved occupational environment: A cross-sectional study of its practice, facilitators, barriers, and benefits among medical practitioners in Nigeria. Indian J Occup Environ Med 2021;25:101-5

How to cite this URL:
Iloh GU, Ikwudinma AO, Emeka EA, Obi IV. Preventive health evaluation in underserved occupational environment: A cross-sectional study of its practice, facilitators, barriers, and benefits among medical practitioners in Nigeria. Indian J Occup Environ Med [serial online] 2021 [cited 2021 Jul 27];25:101-5. Available from: https://www.ijoem.com/text.asp?2021/25/2/101/321072





  Introduction Top


The health of medical doctors (MDs) has been the focus of global concern in Nigeria.[1] and other parts of the world[2],[3] in addition to the recently modified Physician Oath now called “The Modern Physician Pledge,” which states inter alia that “I WILL ATTEND TO my own health, wellness, and abilities in order to provide care of the highest standard.”[4] As a member of human family, MDs are also prone to diseases they manage in healthcare environment.[5],[6] Of great interest is that the burden of preventable diseases among MDs is likely to be underestimated and sometimes overlooked due to self-medications and unwillingness of MDs to assume the role of patients.[7],[8]

Preventive health evaluation (PHE) refers to measures taken for disease prevention which is used to identify persons with increased risk of preventable diseases before they have subjective complaints and objective findings.[9],[10] Globally, several declarations have emphasized optimal health for everyone, everywhere leaving nobody behind including MDs as dictated in the Health For All,[11] Millennium Development Goals,[12] and Sustainable Development Goals.[13]

Research studies have reported various causes of diseases among MDs in different parts of the world and these include hypertension,[14] diabetes mellitus,[15] obesity,[16] metabolic syndrome,[16] and cancers.[17] Of great enthusiasms is the documentary reports of sudden deaths among MDs different parts of the world.[18],[19],[20],[21] Aside work-life disparities and various degrees of burnout reported among MDs in various parts of the world,[22] research studies have shown the existence of inappropriate lifestyles and other risk factors of premature deaths among MDs.[1],[20],[21],[23] Despite the development of guidelines[10] for PHE and evidence of benefits of preventive health services, factual uptake of PHE is low among MDs particularly in resource-constrained settings.[1],[7],[24] The current trend of fatal and silent heart attacks, and strokes among MDs in different parts of the world[18],[19],[20],[21] therefore opens the doors to preventive health evaluation and care.

Several factors have been documented to constitute barriers and facilitators to the uptake of PHE globally.[9],[25] However, researchers have discussed the role of different levels of prevention in health–disease continuum with evidence of benefit predominantly documented.[9],[25] However, in resource-constrained context of Nigeria where healthcare is driven by curative services with little emphasis on preventive health care; PHE among MDs is alarmingly suboptimal.[1] This study was therefore conducted to provide data that would help in the identification of specific groups of at risk MDs in whom PHE may be anticipated as well as providing valuable information that can be used to guide PHE particularly for those with inappropriately self-rated health status. It is based on this background that the authors studied the prevalence, facilitators, barriers, and benefits of PHE in a cross-section of MDs in Nigeria.


  Participants and Methods Top


This was a cross-sectional study of 178 public and private medical doctors (MDs) who participated in Continuing Professional Development (CPD) program organized by Christian Medical and Dental Association (CMDA), Abia State chapter for MDs in Nigeria on 29th and 30th November 2018, and during the Annual General Meeting (AGM) of Association of Resident Doctors (ARD), Federal Medical Centre (FMC), Umuahia held on 8th December 2018.

Sample size was determined using online sample size calculating software [available at www.surveysystem.com]. The input criteria for sample size estimation was set at 95% confidence level, and accessible sample of 300 MDs based on the previous summative CMDA, Abia State CPD and ARD, FMC Umuahia AGM attendance registers. The calculated sample size was 169 participants. The sample size calculating software assumed maximum possible proportion of 50% (0.50). To deal with incomplete response to the items on the questionnaire the estimated sample size was increased by 5% incomplete response proportion, thus sample size = n/1-incomplete response proportion at 5%. This gave a sample size of 177 respondents. However, 178 participants were used for the study. The eligible MDs were consecutively recruited for the study.

The questionnaire consisted of sections on demographic characteristics, information on practice, facilitators, barriers, and benefits of PHE. Self-rated health (SRH) status was also studied. Practice of PHE was inquired in previous year. The questions on practice, facilitators, barriers, and benefits of PHE sections of the questionnaire were designed by the researchers to suit Nigerian environment through review of relevant literature on PHE.[1],[7],[8],[10],[24] Self-rated health (SRH) status was studied using 3-item pre-validated SRH questionnaire which elicited responses in a 6-point Likert responses of excellent, very good, good, fair, poor, and very poor with respect to overall health then, overall health in the past 6 months and overall health compare to others of the same age.[26]

The ethical clearance was obtained from Health Research and Ethics Committee of FMC, Umuahia dated 15th October 2018 referenced FMC/QEH/G.596/Vol.10/410. Informed written consent was also obtained from the participants included in the study.

Data were analyzed using Statistical Package for Social Sciences (IBM SPSS) version 21, New York, USA for the calculation of frequencies and proportions for categorical variables and mean for continuous variables.


  Results Top


Of the 178 MDs who participated in the study, 105 (59.0%) were young adults, 64 (39.0%) were middle-aged adults, and 9 (5.0%) were older persons aged ≥60 years. The age of the respondents ranged from 25 to 72 (36 ± 10.2) years. There were 161 (90.5%) males and 17 (9.5%) females. Ninety-six (53.9%) of the participants had years of practice <10 years while 82 (46.1%) had years of practice of ≥10 years.

All the respondents were aware of PHE. One hundred and fifty-five (87.1%) respondents rated their overall health then as excellent then; 142 (79.8%) rated their overall health compared to 6 months ago as excellent, while 169 (94.9%) rated their overall health compared to others of their age as excellent [Table 1].
Table 1: Self-rated health status of the respondents (n=178)

Click here to view


The most common PHE in all ages and both sexes was BP measurements (100%). The most common male-specific PHE was testicular self-examination (87.0%) while the commonest female sex-specific PHE was self-breast examination (100%) [Table 2].
Table 2: General, male-specific and female-specific preventive health evaluation

Click here to view


The commonest facilitator for PHE was family history of hereditary diseases (100%). The most common barrier to PHE was financial restraints (82.0%) while the most common benefit of PHE was early detection of diseases (100%) [Table 3].
Table 3: Facilitators, barriers and benefits of preventive health evaluation (n=178)

Click here to view



  Discussion Top


This study has demonstrated the pattern of self-rated health (SRH) status among the study participants. The finding of larger number of respondents reporting their health status as excellent then, in the previous 6 months and compared to others of the same age despite the fact that some of the medical doctors (MDs) could have one form of health condition or the other is probably a reflection of health optimism among MDs.[1],[7],[8] Admittedly, MDs have a seeming culture that discourages admission of vulnerability to preventable health conditions with self-treatment being the norm.[1],[7],[8],[27] Thus an unhealthy medical doctor (MD) may claim excellent health status when in reality they are ill amidst patients and societal perceptions that MDs are immune from diseases. PHE among MDs is therefore a need of the moment since their well-being is considered an important public health challenge in the recently modified Physician Oath which states inter alia that “I WILL ATTEND TO my own health, wellness and abilities in order to provide care of the highest standard.”[4]

The most commonly practiced general PHE was blood pressure (BP) checks. This could be a reflection of the fact that hypertension is the most prevalent personal and family health condition in the study area with majority of the respondents having family history of hypertension.[28] Hypertension is usually asymptomatic and due to its high prevalence, BP checks should be done more frequently particularly among MDs with a high-normal BP values, family history of hypertension, and personal history of cardio-metabolic risk factors that frequently cluster with hypertension.[14],[16],[28] Agreeably, when the health of a MD is compromised due to hypertensive disorder and its complications, so may the quality of care provided by the affected MD.[22] MDs shouldn't spend time measuring BP of patients and forget to measure their own BP regularly.

The commonest male-specific PHE was testicular self-examinations (TSE). As a reproductive health tumor, the prevalence of testicular tumors is rare among black males but the healthcare evaluation for testicular tumor is for every male as early stages of testicular cancers are symptomless.[29] TSE helps in identifying early testicular tumors when treatment is more effective and beneficial. It is recommended that all men from pubertal age should practice TSE at least once a month.[29]

TThe commonest female specific PHE was self breast examination (SBE). The finding of this study is in tandem with previous reports that SBE is routinely performed by women.[10],[30] The finding could be a reflection of the fact that breast cancer is the most common cancer among the females with high morbidity and mortality reported particularly in resource-poor environment.[30] Although there are several recommendations for screening for breast cancer among the females but women at high risk should begin early and continue as long as they are in good health.[30] Breasts cancer have multi-factorial etiologies involving cascade of events that unfold months to years prior to manifestations. The performance of SBE among female MDs is safe, effective, and practical alternative to mammosonography, mammogram, and biopsy studies especially in a resource-constrained environment.

The most common facilitator of PHE was family history of hereditary diseases. Although the parameters for PHE depend on the MDs age, gender, and individual risk factors but the good news is that preventable familial diseases lend itself to strategic control at primary and secondary levels of prevention.[10],[25] PHE among MDs with family history of hereditary disease can be used to identify individuals with risk factors of diseases aimed at altering the course of the disease through targeted health promotion.[25] There is need for MDs with family history of diseases to undergo appropriate PHE to enable them remain in state of wellness throughout the period of practice of medicine and beyond. This is the need of the moment in the face of reported increasing and alarming sudden death among MDs,[17],[18],[19],[20],[21] although nothing in human life lasts forever but PHE increases the delivery of PHC and should never be dismissed with a wave of hand that it is not my portion.

The commonest barrier to PHE was financial restraint. The finding of this study is in contradiction with reports from developed nations where time constraint was the commonest barrier to PHE among MDs.[2],[3] Of great concern is that despite the financial barrier and other constraints such as time for PHE, MDs in Nigeria are reluctant to engage in PHE and tend to delay seeking PHC as well as find it difficult to adopt the role of persons with risk factors of preventable diseases.[1] Of mindboggling is that the financial restraint to PHE could also augment the decision to delay seeking timely medical care for overt medical conditions as well as promote the culture of the MD working through ailments.[1],[3],[7],[8] As MDs endeavor to achieve excellence in medical career, they shouldn't forget that the most important aspect of professional life is optimal health without which they wouldn't be able to achieve work-life balance.

The commonest benefit of PHE was early detection of diseases. Although patients' care takes central stage in medical practice but the epitome of best medical practice depends on how MDs take care of their health in order to provide high quality care to the patients. As dictated in The Modern Physician pledge, “THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration.”[4] MDs should constantly remind himself that he is a human being first and a physician secondly and are not immune to diseases that befall humans. MDs should always attend to their duty of patient care but should never forget to do PHE and other relevant medical care as and when due.

Limitations of the study

The study was based on participant's subjective responses. The list of PHE services is not exhaustive and individual clinical decisions should be made based on a person to person basis. However, high risk MDs may require additional PHE beyond that recommended for the general population.


  Conclusion Top


Awareness of PHE was 100% but didn't translate to comparative general practice orientation in the previous 1 year. The most common PHE was BP measurements. The commonest preventive female and male sex-specific PHE was self-breast and testicular examinations respectively. The predominant facilitator and barrier to PHE were family history of hereditary diseases and financial restraints. The most common benefit was early detection of diseases.

Declaration of participant's consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Fawibe AE, Odeigah LO, Akande TM, Salaudeen AG, Olanrewaju I. Self-reported medical care seeking behavior of doctors in Nigeria. Alexandria J Med 2017;53:117-22.  Back to cited text no. 1
    
2.
Gardner M, Ogden J. Do GPs practice what they preach? A questionnaire study of GPs treatments for themselves and their patients. Patient Educ Counselling 2004;56:112-5.  Back to cited text no. 2
    
3.
Schneck SA. Doctoring doctors and their families. JAMA 1998;280:2039-42.  Back to cited text no. 3
    
4.
Parsa-Parsi RW. The revised declaration of Geneva: A modern-day physician's pledge. JAMA 2017;318:1971-2.  Back to cited text no. 4
    
5.
Lin CM, Yang CH, Sung GC, Li CY. Risks and causes of hospitalizations among physicians in Taiwan. Health Services Res 2008;43:675-92.  Back to cited text no. 5
    
6.
Tyssen R. Health problems and use of health services among physicians: A review article with particular emphasis on Norwegian studies. Ind Health 2007;45:599-610.  Back to cited text no. 6
    
7.
Kay MP, Mitchell GK, Del Mar CB. Doctors do not look after their own physical health. Med J Aust 2004;181:368-70.  Back to cited text no. 7
    
8.
Grantham H. Doctors as patient. Part 2: The realities of life as a patient. Aust Fam Physician 2002;31:179-81.  Back to cited text no. 8
    
9.
Patterson C, Chambers LW. Preventive health care. Lancet 1995;345:1611-5.  Back to cited text no. 9
    
10.
Julien G, France M, Michel N, Xavier D. Preventive services recommendations for adults in primary care settings: Agreement between Canada, France and the USA—A systematic review. Prev Med 2013;57:3-11.  Back to cited text no. 10
    
11.
World Health Organization. Definition of health from World Health Organization Constitution. The Same Is Re-Affirmed by the Alma Ata Declaration. World Health Organization; 2006.  Back to cited text no. 11
    
12.
Waage J. The millennium development goals: A cross-sectional analysis and principles for goal setting after 2015. Lancet 2010;376:991-1023.  Back to cited text no. 12
    
13.
Wackernagel M, Hanscom L, Lin D. Making the sustainable development goals consistent with sustainability. Front Energy Res 2017;5:18.  Back to cited text no. 13
    
14.
Nigudgi SR, Ajaykumar G, Tenglikar SG, Shrinivasreddy B. Prevalence of hypertension among doctors working in M. R. Medical College, Gulbarga. RGUHS J Med Sciences 2013;3:10-2.  Back to cited text no. 14
    
15.
Busari OA, Opadijo OG, Adeyemi AO. Risk of developing diabetes among healthcare workers in a Nigerian Tertiary Hospital. Mera Diabetes Int 2008;16:21-2.  Back to cited text no. 15
    
16.
Cheng TO. Overweight and obese physicians in the United States, physician, heal thyself. Int J Cardiol 2006;107:114.  Back to cited text no. 16
    
17.
Yousef V, Ali D. Comparison of cancer prevalence in physicians with that of the general population, and important considerations. Korean J Fam Med 2016;37:308.  Back to cited text no. 17
    
18.
Egbule M. UBTH resident doctors mourning surgeon who died on duty. Available from: guardian.ng/news/ubth-resident-doctors-mourning-surgeon-who-died-on-duty/[Last accessed on 2018 Nov 7].  Back to cited text no. 18
    
19.
Medical doctor dies after watching Nigeria vs Argentina match. Available from: punch.com/medical-doctor-dies-after-watching-nigeria-vs-argentina-match/[Last accessed on 2018 Jun 28].  Back to cited text no. 19
    
20.
Gao L, Xiao X, Che G, Zhang L. Sudden death of physicians in China: A red alert. Popul Health Manag 2019;22:191-2.  Back to cited text no. 20
    
21.
Samkoff JS, Hockenberry S, Simon LJ, Jones RL. Mortality of young physicians in the United States, 1980-1988. Acad Med 1995;70:242-4.  Back to cited text no. 21
    
22.
Lee RT, Seo B, Hladkyj S, Lovell BL, Schwartzmann L. Correlates of physician burnout across regions and specialties: A meta-analysis. Human Res Health 2013;11:48.  Back to cited text no. 22
    
23.
Aghaji MN. Doctors lifestyle in Enugu, Nigeria. East Afr Med J 2000;77:480-4.  Back to cited text no. 23
    
24.
Campbell S, Delva D. Physician do not heal thyself: Survey of personal health practices among medical residents. Can Fam Physician 2003;49:1121-7.  Back to cited text no. 24
    
25.
Temporelli PL, Zito G, Faggiano P. Cardiovascular risk profile and lifestyle habits in a cohort of Italian cardiologists (from the SOCRATES Survey). American J Cardiol 2013;112:226-30.  Back to cited text no. 25
    
26.
Idler EI, Hudson SV, Leventhal H. The meanings of self-rating of health: A qualitative and quantitative approach. Res Aging 1999;21:458-76.  Back to cited text no. 26
    
27.
Eromme E, Herbert R, Carrese J. Self-doctoring: A qualitative study of physicians with cancer. J Fam Pract 2004;53:299-306.  Back to cited text no. 27
    
28.
Iloh GUP, Amadi AN. Essential hypertension in adult Nigerians in a primary care clinic: A cross sectional study of the prevalence and associated family socio-biological factors in Eastern Nigeria. Eur J Prev Med 2014;2:81-9.  Back to cited text no. 28
    
29.
Moul JW. Timely diagnosis of testicular cancer. Urol Clin North Am 2007;34:109-17.  Back to cited text no. 29
    
30.
Johnson OE. Awareness and practice of breast self-examination among women in different African countries: A 10-year review of literature. Niger Med J 2019;60:213-9.  Back to cited text no. 30
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
Print this article  Email this article