Endorsed by. Article Information Authors: Akinwumi O. Owolabi 1 Mojisola O. Owolabi 1 Akintayo D. Work-related stress perception and hypertension amongst health workers of a mission hospital in Oyo State, south-western Nigeria. The Authors. This is an Open Access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Work-related stress perception and hypertension amongst health workers of a mission hospital in Oyo State, south-western Nigeria In This Original Research Open Access. Article Information. Authors: Akinwumi O. In This Original Research Work stress is at present already acknowledged as one of the epidemics of modern working life. It is associated with a number of disease conditions, such as hypertension, cardiovascular diseases , affective disorders, depression, disturbed metabolism risk of Type II diabetes and musculoskeletal disorders.
Objective: This study was a work site cross-sectional descriptive study carried out amongst the health workers at the Baptist Medical Centre Ogbomoso, Oyo State, south-western Nigeria. The aim of the study was to discern the prevalence of perceived work stress and to explore the relationship between perceived work stress and the presence of hypertension.
Methods: A total of consenting health workers of the institution were administered the job demand-control questionnaire to assess work stress. A standardised questionnaire was used to collect socio-demographic data and other personal data. Measurements of blood pressure, weight and height were carried out and body mass indices were calculated.
Results: More than a quarter The single largest group of hypertensive subjects was seen amongst subjects with work stress. Conclusion: A significant number of health workers in this study is afflicted by work-related stress and perceived work stress was found to be significantly associated with higher hypertension prevalence. Work-related stress follows a pattern of reactions that occurs when workers are presented with work demands not matched to their knowledge, skills or abilities and which challenge their ability to cope.
Stress may also operate on a background of genetic susceptibility and interact with other lifestyle determinants of hypertension such as obesity, physical inactivity, over-eating, smoking, excessive salt intake and excessive alcohol consumption. The aim of this study, therefore, was to determine the prevalence of perceived work stress and to explore the relationship between perceived work stress and the presence of hypertension amongst the health workers of the Baptist Medical Centre, Ogbomoso.
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The Baptist Medical Centre is a bed mission hospital, run by health workers. It was founded in and it provides primary, secondary and tertiary health-care services. Occupational stress has been a long-standing concern of the health-care industry and studies from developed countries indicate that health-care workers have higher rates of substance abuse, suicide and elevated rates of depression and anxiety, linked to job stress, than other professionals.
Ethical considerations.
Written consent was obtained from each of the subjects before they were included in the study. The study was carried out in the workplace and the subjects were the health workers of the Baptist Medical Centre, Ogbomoso, Oyo State. All consenting health workers of the institution were enrolled for the study. All hypertensive staff with reported history of secondary hypertension and all pregnant women were excluded from the study. Samples and population The age, gender, marital status, religion, nationality, occupation, educational status, physical activity, family type, history of alcohol consumption or cigarette smoking, history of hypertension, family history of hypertension, history of diabetes, ethnic group, and level of education were obtained from the subjects by using a structured questionnaire.
Procedure The blood pressure of each subject was measured by using the same mercury sphygmomanometer with a cuff size of The cuff of the sphygmomanometer was applied evenly and snugly around the bare arm with the lower edge at least 2. Thereafter the cuff was deflated slowly whilst listening with a stethoscope placed over the brachial artery in the ante-cubital fossa.
The onset of the first tapping sound Phase I was taken as the systolic pressure, whilst the point of complete disappearance of the sound Phase V was taken as the diastolic pressure for each subject. Subjects were weighed barefooted in light clothing, and the same weighing scale was used for all the subjects and readings were expressed to the nearest 0. Underweight , BMI Normal weight , BMI The self-administered questionnaire contained 11 items that concerned the psychosocial aspects of work, each graded on a 4-point scale.
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The items were selected from several sources, based on its particular suitability for measuring job stress in a heterogeneous population. Median values of job demand and job control latitude was used to divide the subjects into four groups, namely: the high strain group, the active group, the passive group and the low strain group. Subjects displaying a job demand higher than the median and a job decision latitude lower than the median, represented the high-strain group.
Subjects reporting a high decision latitude and a high job demand were in the active group. Subjects with a low job demand and low decision latitude were in the passive group. Subjects with a low job demand and a high decision latitude were in the low-strain group. It is important to mention that the generalisability of the job demand-control questionnaire makes it possible to draw comparisons amongst different medical and non-medical occupational groups and this was an important factor in selecting the questionaire.
However, it is likely that many cases of dengue in Nigeria are often undiagnosed or misdiagnosed as malaria or referred to as fever of unknown cause. Although there have been several reported isolated outbreaks of dengue infection, still it is likely that many outbreaks have been neglected, un recognized and under-reported due to unavailability of diagnostic tools and staff unawareness in health institutions [ 12 ]. A clear method of identifying dengue infection from among other acute undifferentiated tropical febrile illnesses is vital to facilitate appropriate triage of patients and better clinical management of dengue cases.
Because healthcare facilities in many dengue endemic countries lack laboratory support, such simple diagnostic tests are desirable. Dengue IgM levels begin to rise by the third day of a primary infection and peak at 2 weeks after the onset of fever and may remain detectable for up to 6 months or longer following disease resolution. IgG is detectable at the end of the first week of illness and can persist for life. The diagnosis of dengue is further complicated by malaria co-infection as demonstrated in our study.
Among this cohort of malaria cases, all of them were found to be positive for dengue IgG antibodies suggestive of a past dengue infection and consistent with endemicity of dengue virus in this area [ 26 ]. All these reflect a significant public health challenge that needs to be prioritised. The use of mosquito nets has been recognised to be the most effective strategy for malaria control [ 27 ], but the use of mosquito treated nets among this cohort did not meet the targets set for malaria control in an endemic area.
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Effective use of the long-lasting insecticide treated nets LLIN has been shown to significantly reduce the transmission of Aedes -borne diseases such as dengue, Zika, yellow fever and chikungunya [ 28 ]. Therefore, the LLIN appears to hold much promise for the control of the diseases transmitted by these endophilic mosquitoes and its widespread use should be promoted in the relevant climes. The erroneous belief that malaria accounts for virtually all cases of fever in Nigeria is widespread among the populace.
It is commonplace for persons with fever in Nigeria to self-medicate with two or three antimalarial drugs before presenting to a health facility [ 31 ]. This is consistent with the findings here. Following improvements in malaria control efforts in low-middle income country LMIC contexts, it is believed that bacterial and viral pathogens account for the majority of cases of acute febrile illnesses [ 32 , 33 ]. However, there appears to be limited baseline understanding of these pathogens with a disproportionate focus on malaria leading to misdiagnosis and unwarranted treatment.
This may result in a misapplication of scarce resources and inadvertently drive resistance to the currently available antimalarials. Indeed the preoccupation with malaria in the LMICs may be constituting a barrier to understanding the complex communicable diseases epidemiology that characterise these countries. Rapid population growth, unplanned urbanization, increased international travel, agricultural development, possible global climate changes are some of the factors that have been put forward to explain the extensive transmission of dengue in these areas [ 34 ]. Other enabling factors include ineffective mosquito control measures and the limited allocation of resources to public health infrastructure [ 35 ].
However, none of the variables in our logistic regression model namely age, sex, education, place of residence, presence of waste around house, presence of water storage at house, and the use of any household malaria prevention strategies were associated with dengue infection status. It is not clear why no associations were found, but limited sample size and therefore power may be a major reason.
Clearly there is need it for algorithmic guidelines, including universal malaria and selective dengue testing, for the diagnosis and management of patients with fever presenting to primary and secondary care in Nigeria. This pragmatic framework for triage and testing of undifferentiated cases of fever in resource limited settings is critical in determining the clinical outcomes of patients with dengue.
These guidelines will need to reflect the fact that about half of these undifferentiated cases are neither due to malaria nor dengue, but may rather be related to respiratory or urinary infections. Such guidelines will need to include methods of identifying dengue related complications to promote optimum management and referral of relevant cases. Surveillance for dengue is vital in this setting for identifying outbreaks and initiating an early response.
This study has several limitations. First, our survey did not use a probability sampling method, given that although we took a probability sample of health facilities we had to take a non-probability sample of patients from within those facilities. This therefore prevented the calculation of weights and limits the robustness and generalisability of the estimates, given that inferential statistics formally assume the data come from a random probability sample.
Second, this is a facility-based survey, and so we cannot generalize our results to the community or wider population outside of those attending health facilities for fever, which would require a population survey. Third, dengue shows seasonal trends, and the data were collected over a large proportion of the year and importantly with uneven effort across that time period. Hence, the overall percent prevalence estimates do not represent the prevalence from any single part of the year, nor do they represent an evenly sampled average across the whole year.
The results should therefore be treated cautiously as likely indicative of the broad level of dengue infections in patients attending PHCs with fever. Fourth, we were unable to definitively determine the proportion of patients with other febrile conditions. We are grateful to the staff of the various health facilities in Cross River State Nigeria who facilitated our recruitment of participants. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field.
Abstract Background In Nigeria, recent reports suggest that dengue viruses could be a major cause of acute fevers.
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Conclusion Our study confirms the presence of dengue at not insignificant levels in patients attending health centres with fever in this south eastern province of Nigeria. Introduction Dengue is the most important arboviral infection of humans caused by four dengue virus serotypes, namely dengue virus 1,2,3, and 4 DENV 1—4 , which belong to the Flaviviridae family [ 1 ]. Methods Study setting In Cross River State there are primary health-care centres PHCs and secondary health-care centres, distributed across eighteen local government areas LGAs , covering a population of approximately 3,, [ 14 ].
Study design and sample size This cross-sectional facility survey was conducted between January and August in health facilities mostly PHCs across Cross River State.