|Year : 2013 | Volume
| Issue : 2 | Page : 90-97
Health problems and associated risk factors in selected urban and rural elderly population groups of South-West Nigeria
Kayode A Abegunde, Eme T Owoaje
Department of Community Medicine, College of Medicine, University of Ibadan, University College Hospital Campus, Queen Elizabeth Road, Mokola, Ibadan, Oyo State, Nigeria
|Date of Web Publication||22-May-2013|
Kayode A Abegunde
Department of Community Medicine, College of Medicine, University of Ibadan, University College Hospital Campus, Queen Elizabeth Road, Mokola, Ibadan, Oyo State
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: The increasing number of the elderly persons and their attendant health problems has implications on public health programs in developing countries. However, there is limited information on the elderly residing outside major cities in Nigeria. Therefore, this study was conducted to determine and compare prevalent health problems and associated risk factors in the elderly of urban and rural communities in Oyo State, Nigeria.
Materials and Methods: A comparative cross-sectional survey of consenting adults aged 60 years and above in Iseyin (urban) and Ilua (rural) communities of Oyo State in south-west, Nigeria. Using cluster sampling technique, a total of 630 respondents; 316 in the urban and 314 in the rural participated. Information was sought on the respondents' socio-demographic characteristics, life style, self-reported health problems. Anthropometric measurements and clinical examination including blood pressure measurements and visual acuity were conducted.
Results: The mean age of urban respondents was 72.2 ± 9.5 years compared with 70.8 ± 8.1 years in the rural. There were more females (61.1%) than males (38.9%) in both the locations. Self-reported health problems in both locations were similar and included reduced sexual fulfillment, musculoskeletal problems such as muscular and low back pain. On clinical examination, the main health problems were visual impairment 58.7% in the urban versus 41.7% in the rural ( P < 0.001). Prevalence of hypertension among urban and rural respondents was 38.3% and 34.7%, respectively ( P = 0.35). Osteoarthritis was significantly higher 8.5% in urban than 3.2% obtained in rural ( P = 0.004v). On multivariate analysis, female gender, increasing body mass index, and low monthly income were significant predictors of hypertension in both locations.
Conclusions: Cardiovascular, musculoskeletal, and visual noncommunicable diseases were prevalent in both elderly populations. Social conditions and gender play important role in the health status of the elderly.
| Abstract in French|| |
Contexte: L'augmentation de nombre de personnes âgées et de leurs problèmes de santé connexes influe sur les programmes de santé publique dans les pays en développement. Cependant, il y a peu de données sur les personnes âgées résidant à l'extérieur des grandes villes du Nigeria. Par conséquent, cette étude a été réalisée à déterminer et de comparer les problèmes de santé fréquents et facteurs de risque chez les personnes âgées des communautés urbaines et rurales dans l'état d'Oyo, Nigéria.
Méthodes et matériaux: Transversale de A comparative survey de consentants adultes âgées 60ans et plus Iseyin (zone urbaine) et Ilua collectivités (rurales) de l'état d'Oyo au sud-ouest, Nigeria. À l'aide de la technique d'échantillonnage de cluster, un total de 630 répondants ; 316 dans les zones urbaines et 314 dans les zones rurales ont participé. Les renseignements ont été demandés sur les caractéristiques sociodémographiques des répondants, style de vie, déclarés par les problèmes de santé. Mesures anthropométriques et examen clinique, y compris les mesures de tension artérielle et acuité visuelle ont été menées.
Résultats: L'âge moyen des répondants urbains était de 72.2 ± 9.5 ans contre 70.8 ± 8.1 ans dans les zones rurales. Il y avait plus de femmes (61.1%) que chez les hommes (38.9%) dans les deux endroits. Déclarés par les problèmes de santé dans les deux sites étaient similaires et inclus réduit accomplissement sexuel, problèmes musculo-squelettiques tels que maux de dos musclé et faible. Examen clinique, les principaux problèmes de santé ont une déficience visuelle 58.7% dans les zones urbaines par rapport à 41.7 % dans les zones rurales (P < 0,001). Prévalence de l'hypertension chez les répondants urbains et ruraux a été de 38,3 % et 34.7%, respectivement (P = 0.35). L'arthrose a été significativement plus élevée 8.5% en urbain que 3.2% obtenu dans les zones rurales (P = 0.004). Analyse multivariée, sexe féminin, augmentant à indice de masse corporelle et faible revenu mensuel étaient des prédicteurs significatifs de l'hypertension dans les deux endroits.
Conclusions: Circulation sanguine, musculo-squelettique et visuelle des maladies non transmissibles ont été répandus dans les deux populations âgées. Entre les sexes et les conditions sociales jouent le rôle important dans l'état de santé des personnes âgées.
Mots clés: Personnes âgées, problèmes de santé, état d'Oyo, facteurs de risque, Sud-Ouest Nigérian collectivités
Keywords: Elderly, health problems, Oyo state, risk factors, south-west Nigerian communities
|How to cite this article:|
Abegunde KA, Owoaje ET. Health problems and associated risk factors in selected urban and rural elderly population groups of South-West Nigeria. Ann Afr Med 2013;12:90-7
|How to cite this URL:|
Abegunde KA, Owoaje ET. Health problems and associated risk factors in selected urban and rural elderly population groups of South-West Nigeria. Ann Afr Med [serial online] 2013 [cited 2020 Jan 28];12:90-7. Available from: http://www.annalsafrmed.org/text.asp?2013/12/2/90/112398
| Introduction|| |
The 20 th century witnessed in many regions of the world, increased numbers of the elderly. This was mainly due to the control of perinatal and infant mortality, a decline in birth rates, improvement in nutrition, basic health care, and the control of many infectious diseases. This combination of factors has resulted in an increasing number and proportion of persons surviving into the advanced stages of life. ,
The continued increase in the proportion of the elderly is projected to continue to occur more in the developing countries than their developed counterparts in the future decades. This is due to the fact that the developing countries are in the second stage of demographic transition, where there is high birth rate and low death rate compared with the developed countries that are in fourth stage of the demographic transition, where low birth rate balances low death rate.  In Nigeria, the life expectancy has increased from 37 years at independence in 1960 to about 50 years currently.  Increase in life expectancy has been associated with increasing prevalence of chronic diseases, disability dependent life, and utilization of costly health care services. , Although many individuals can now look forward to longer lives, the risk of having at least one chronic disease such as hypertension, or diabetes increases with age. Old age can therefore, be likened to a hospital where one can find various ailments. The increasing number of elderly persons and their attendant health problems have implication on public health programs in developing countries including Nigeria. However, there is limited information on morbidity pattern of the elderly residing outside major cities in Nigeria. As a greater proportion of the population survives to very old ages, the public health impact of the burden of disease and need for supportive and long-term care has become an important concern. , Similarly, the increasing number of elderly persons poses peculiar health, social, and economic challenges. However, surveys carried out in Nigeria have been mainly hospital-based, and in major cities and therefore have not provided sufficient information on the health problems at the community level. In order to develop adequate health care strategies targeted at the needs of the elderly, information on the pattern of specific acute and chronic health conditions is required. This information would be important for the development of appropriate primary health care programs for the elderly at the community level.
| Materials and Methods|| |
This study was carried out in Iseyin an urban community and in Ilua a rural, predominantly tobacco farming community which are about 20 km apart; both located in Oke-Ogun area of Oyo State, Nigeria. Iseyin and Ilua are about 150 km and 170 km, respectively, from Ibadan the capital of Oyo State in south west Nigeria. These two communities are close enough to Ibadan to be influenced by the on-going modernization process, yet far enough to retain certain traditional ways of living. The residents were mainly of Yoruba ethnicity. Participants in the study were household members who were aged 60 years and above, and residing in Ilua or Iseyin. Their ages were determined by direct enquiry, or estimated by the use of historical events, age at marriage and age of their eldest child. Information on health problems experienced in the 3 month period prior to the date of interview was obtained from them. In situations where an elderly individual could not provide information themselves due to dementia, dumbness, deafness, or psychiatric illness, a reliable informant was interviewed to obtain information on health problems of such a participant.
Cluster sampling technique was used in the study; having obtained a list of all the compounds ("Agbo-Ile") in both communities from the local government. From a previous rapid assessment of Ilua, it was estimated that there were about 30 houses per compound, an average of two families inhabiting each house with about 2-3 elderly in each house. Each compound was taken as a cluster; and five (5) clusters were selected using simple random sampling technique. All consenting elderly people in the households in the selected clusters were interviewed. A list of all the compounds in Iseyin town was obtained from Iseyin local government secretariat. A sample of the compounds in Iseyin provided an average of 25 houses per compound, on average, two families co-habited in each house with about 1-2 elderly in each house. Each compound was taken as a cluster; twelve (12) clusters were selected using simple random sampling technique. All houses in those clusters were selected; and all consenting elderly people in the households in the selected houses were interviewed.
A pretested interviewer administered questionnaire was used to obtain data. The questionnaire consisted of four sections which focused on the following: (1.) Socio-demographic data of the respondents, (2.) Social, family, living status, and lifestyle which included (smoking, use of nonsmoked tobacco, alcohol consumption, and exercise) history, (3.) Self-reported health problems of the elderly, and (4.) Health problems for which care was sought in the last 3 months and physical examination findings. The questionnaire was administered by six research assistants who were either nurses or community health extension workers.
The respondents interviewed by the research assistants were sent to a predetermined central place in the community where the anthropometric measurements and clinical examinations were conducted by the principal investigator. This was to improve consistency of measurements and validity of the physical examination findings and diagnosis. The respondents were examined for pallor, jaundice, dehydration; a pen touch was also used to examine the anterior aspect of the eye for the presence of ocular abnormalities such as cataract (visible lenticular opacities or history of cataract operation), pterygium, and cornea opacity. Oral examination was also carried out to determine the state of oral hygiene and to determine those with missing teeth.
Diagnoses of diseases were made on the basis of medical history obtained from the elderly, clinical evaluation, diagnosis and/or treatment of diseases conducted earlier elsewhere and available investigation reports. Height was measured using a model 424 Weylux stadiometer positioned on a flat surface. The participants were asked to remove their shoes and headwear before stepping on to the device;  the hair was flattened temporarily with a hard, flat, and movable headboard on the stadiometer. The weight of each participant was measured using a weighing scale manufactured by Harson ® , Japan. Measurement were made to the nearest 0.1 cm  and converted to meters thereafter, for the calculation of the body mass index (BMI).
The weighing scale was placed on a flat horizontal surface; the scale was checked before each weighing and adjusted to zero. It was also tested daily using objects of known weight to ensure accuracy. The participants were then asked to stand on the scale, and weighed wearing minimal clothing. All readings were made by the researcher standing in front of the patient. Weight was recorded in kilograms to the nearest 0.5 kg.
Blood pressure was measured using an Accoson ® mercury sphygmomanometer which was calibrated and validated before use each day. The blood pressure was measured after participants had been sitting quietly for at least 5 minutes on the right arm with the appropriate cuff size.  Systolic and diastolic blood pressures were recorded to the nearest 2 mmHg as the first and fifth Korotkoff sounds, respectively. , Two blood pressure readings were taken, and the average of two such systolic and diastolic blood pressure readings was taken as the examination blood pressure. 
The respondent's joints were also examined. Osteoarthritis was diagnosed from the typical history, presence of bone crepitus or joint deformity on examination. 
Visual acuity of the respondents was measured using the illiterate version of the Snellen's chart (with letters 'E') placed on a flat wall. The respondents were made to stand 6 m from the chart after the procedure had been explained to them. The right eye was measured first with the left eye covered with an opaque cardboard, and vice versa. The patient was asked to determine the directions of the letters 'E' (illiterate version) on the chart and the best read line was recorded for each eye. In the event that a respondent could not read the chart at 6 m, he/she was made to attempt reading again at 3 m to the chart. This measurement was done without glasses and with glasses for participants who used glasses.
The BMI of each respondent was calculated from the height in meters and weight in kilograms. BMI is the weight in kilograms divided by the height in meters squared. , BMI was categorized into four groups: Chronic energy deficiency (CED), normal BMI, overweight, and obesity. CED was defined as BMI <18.5 kg/m 2 and BMI 18.5-24.9 kg/m 2 was considered normal.  Overweight was described by a BMI of 25.0-29.9 kg/m 2 , while obesity was described as BMI greater than 30.0 kg/m 2 . 
Hypertension was defined using the Joint National Committee on Detection, Evaluation and treatment of high blood pressure (JNC VI) recommendations of a systolic blood pressure of 140 mmHg or higher and/or the use of medications for the purpose of treating high blood pressure. , Borderline hypertension was defined as systolic blood pressure of 140-159 mmHg and diastolic blood pressure of 90-99 mmHg. Moderate hypertension was defined as systolic blood pressure of 160-179 mmHg and diastolic blood pressure of 100-109 mmHg. Severe hypertension was defined as systolic blood pressure of 180-199 mmHg and diastolic blood pressure of 110-119 mmHg.
Based on the International Classification of Diseases 10 th edition (ICD 10), blindness was defined as vision less than 3/60 in the better eye with the best possible correction; low vision was taken as vision in the better eye worse than 6/18. 
Statistical analysis was performed using SPSS software. Frequency counts (expressed in percentages) were used for all variables and the medical conditions diagnosed. Prevalence of health problems were calculated separately for both groups. Bivariate analysis was performed to determine associations between some background characteristics and osteoarthritis; while logistic regression was used to determine the odds ratio (OR) for each category of independent variable that were significant at 10% on bivariate analysis while controlling for the effect of other potential risk factors. Statistical significance was set at P < 0.05.
| Results|| |
In all, 640 elderly were approached to participate in the study; 630 of them consented to participate, giving a response rate of 98.4%, 316 from urban, 314 from rural. Their ages ranged from 60 to 110 years and the mean age of respondents in the urban community was 72.2 ± 9.5 years compared with 70.8 ± 8.1 years for those in the rural The 630 respondents comprised 245 males (38.9%) and 385 females (61.1%). The socio-demographic characteristics of the respondents are presented in [Table 1]. Most respondents were married, while about one-third of them were widows/widowers. Majority of the respondents in both population were Yorubas and more than half of them were moslems/muslims. Most of them were either currently trading or farming.
With regard to important lifestyle characteristics, there was a significant difference in the frequency of use of other forms of tobacco between both groups (χ2 = 11.996; P < 0.007). Similar ly, respondents from the rural were more likely to be currently drinking alcohol (P = 0.023). [Table 2] shows the self-reported health problems of the elderly by location; the most prevalent in both locations were reduced sexual fulfillment (76.2%), joint pain (60.3%), general body pains (52.7%), and blurring of vision (46.3%). The most prevalent health problems for which care was sought in the 3 month period prior to the study in the urban location were febrile illness (22.6%), musculoskeletal-related disorders (22.0%) (especially osteoarthritis) ranks next, cardiovascular problems (especially hypertension) (12.6%) followed by respiratory problems (cough and catarrh) (11.3%), and general symptoms (10.1%). In the rural area, musculoskeletal problems were the most prevalent (22.4%) followed by general symptoms, respiratory problems, digestive problems, and neurological problems especially (abnormal sensations and sleep disorders). [Table 3] shows the health problems identified on clinical examination. The most common condition diagnosed was visual impairment in both locations 58.7% in urban and 41.7% in the rural. Hypertension was found to be marginally higher in urban group (38.3%) compared with the rural group (34.7%). The prevalence of osteoarthritis was significantly higher (8.5%) in the urban elderly compared with 3.2% in the rural (χ2 = 8.184; P = 0.004). Whereas visual impairment was significantly higher in the rural group. The prevalence of missing teeth was almost the same in both locations 34.4% for urban and 34.8% for rural. A few of the respondents were edentulous; about 1.3% in each of the location.
|Table 3: Health problems of respondents identified on clinical examination by location|
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Logistic regression analysis to find out the impact of selected background characteristics on an important health problem of the elderly (hypertension). Female gender, decreasing monthly income, increasing BMI were predictive of hypertension in both locations. Females were 1.5 times more likely than males to have hypertension (OR = 1.551; 95% confidence interval (CI)=1.008-2.387; P = 0.046). Increasing BMI was a significant predictor of hypertension in both locations with the obese being 2.8 times more likely than those with normal BMI to have hypertension. (OR = 2.8; 95% CI = 1.520-5.287; P = 0.001). Decreasing monthly income was also a significant predictor of hypertension. The odds of having hypertension increases by 0.798 per unit increase in naira (OR = 0.798; 95%CI = 0.677-0.940; P = 0.007).
| Discussion|| |
The elderly experience many chronic diseases, which contribute to the age-related physical incapacitation. This study set out to assess and compare the prevalent health problems of the elderly in Ilua and Iseyin areas of Oyo state, Nigeria. The highest proportion of the respondents in this study fell within the age group of 60-69 years in both locations and the least proportion was within the age group ≥90; this pattern is as expected since the force of mortality increases with age. This finding is similar to other studies. , A higher proportion of those aged ≥90 years were in the urban, apart the mean age being higher in the urban compared with the rural; this might have been due to better health care facilities and better standard of living in the urban compared with rural. In both locations, females constituted a higher proportion of the study population. This finding is similar to what has been reported by other studies; , and this has been attributed to the longer life expectancy of females. 
With regard to the health problems for which care was sought for in the 3 months period prior to the study among the respondents, musculoskeletal problems ranked highest in the rural and second highest in the urban. These findings are similar to the findings of other researchers in which the most prominent health problems among the elderly were related to the musculoskeletal system. ,, In this study, circulatory problems especially hypertension ranked second in prevalence in urban, and fourth in rural; this finding is similar to the study by Ogunniyi et al.  in which the most prevalent health problem reported was that of the cardiovascular system; hypertension being the most frequent diagnosis. The difference in the ranking could be due to the fact that the location in Ogunniyi's study was Ibadan, an urbanized area while Iseyin and Ilua are located in a predominantly agrarian, less developed, Oke-Ogun area of Oyo state.
With regard to the self-reported health problems by the respondents, the five most frequently reported health problems were: related to the urogenital system (majorly reduced sexual fulfillment), musculoskeletal problems (particularly joint and low back pains), and general symptoms (general body pains), digestive system problem (particularly problems with teeth), visual problems (especially blurring of vision). These findings are similar to the findings of Fatusi et al. in Ile-Ife, Nigeria  where the prevalence of erectile dysfunction was 63.9% in men aged 61-70 years. The difference in the prevalence obtained between this study and Fatusi's study might be due to the difference in the age groups of the respondents used; this study used ≥60 years whereas Fatusi focused on the age group 61-70 years only.
The overall prevalence of hypertension was 36.5%. Hypertension was slightly higher in the urban compared with the rural. This finding is in keeping with the findings of Johnson  where the prevalence of hypertension was also higher in the urban area compared with the rural. The slightly higher prevalence of hypertension in the urban location compared with the rural could be attributed to the effects of urbanization on the lifestyle of the people in the urban location such as increased dietary fat and sedentary lifestyle. 
The prevalence of osteoarthritis was higher among urban elderly, this is consistent with the findings of other researchers.  The prevalence of osteoarthritis within the different age groups was, however, not significantly different. Female sex was significantly associated with osteoarthritis in urban location.
Regarding the nutritional status of the respondents, about a quarter of the rural respondents compared with a fifth of the urban respondents had chronic energy deficiency; this finding is similar to that obtained by Mehdi et al. in which the proportion of elderly with CED was higher among the tea garden workers compared with the urban dwellers. The elderly that have normal BMI were about equal in both locations. The proportion of those who were overweight/obese was slightly higher among those residing in the urban compared with the rural. The reason for this may be the introduction of western diets high in salt, fat and low in fiber content in urban compared with rural.
In assessing the visual acuity of the respondents, visual impairment was significantly higher among urban elderly population compared with those in rural. It was also significantly associated with age. Cataract was slightly higher in the urban compared with rural. Pterygium was significantly higher among the elderly in urban compared with the rural elderly population. The prevalence of senile arcus was also higher among the rural elderly compared with the urban.
Orodental problems were very similar in both locations occurring in about a third of the study population. The prevalence of poor oral hygiene was significantly higher in the rural compared with urban. This finding is similar to that of other researchers,  which reported poor dental hygiene as a problem significantly associated with living in the rural area.
The main predictors of hypertension on logistic regression were female gender, increasing BMI, and decreasing monthly income. This finding supports the findings of other authors  where morbidity was significantly associated with unemployment. Another important factor that was associated with hypertension in this study was being overweight/obese which was significantly associated with hypertension and osteoarthritis in both locations and in the urban, respectively.
In this study, alcohol intake was found to be significantly associated with reduced prevalence of hypertension and also a reduction of the prevalence of reduced sexual fulfillment in both locations. However, on logistic regression alcohol intake was not a significant predictor of hypertension.
In conclusion, the prevalent health problem in our study population underscores the need to pay attention to noncommunicable diseases and their risk factors in elderly Nigerians. Removing the modifiable risk factors through increased health awareness would reduce the demand on health and social services in the presence of a mismanaged economy.
Written consents were obtained from those who could read and write, while informed verbal consent were obtained from the respondents who could not read and write; before conducting the interview and carrying out physical examination. Refusal to participate in the study or withdrawal from it did not attract any penalty or loss of opportunity for treatment or follow-up for the respondent.
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[Table 1], [Table 2], [Table 3]