Quantitative metrics and pressures to respond to the student experience

A. i. A mercury in glass sphygmomanometer calibrated from 0 - 300mmHg.

ii A Littman stethoscope (USA).

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iii. A portable bathroom weighing scale (Camry) calibrated from 0 – 120kg, and for those greater than 120kg, a beam balance weighing scale was used together with a 10kg standard weight.

iv. Inelastic tape measure (Butterfly model-made in China), graduated in cm (0 - 150).

v. A vertical wooden bar calibrated in cm (0-200) obtained from a measuring scale nailed on walls in the clinic.

B. A structured pretested questionnaire seeking information on bio-social data and disease characteristics (Appendix C)

C. The World Health Organization quality of life instrument (WHOQOL-Bref) was used to assess the general health related quality of life among respondents (Appendix D).

3.5.1 Method of Data collection

Pretesting of Questionnaires – The semi-structured questionnaire was pre-tested among 10% (21 subjects) of the sample population by debriefing respondents understanding of the questions the way the research was intended. Ambiguity was detected in four semi-structured questions. These questions were modified and pretested again with satisfactory outcome.

Translation of the instrument – The semi-structured questionnaire and the WHOQOL Bref were translated into Hausa and back into English by a linguist. (Appendix E)

Collection of Data: The study was conducted over a period of three months, from February to April 2011. The research was made known to patients waiting in the general or medical outpatient departments during the study to get volunteers. Subjects were selected using the systematic random sampling as described earlier. The questionnaire was completed by the researcher for each of the subjects by direct interview after obtaining a written consent.

The BP, BMI and WHR were obtained after a careful examination.

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Blood pressure measurement: The BP was measured using a mercury sphygmomanometer with the appropriate cuff size. In measuring BP, each subject was made to relax for five minutes (during which the questionnaires were filled). The measurement was in the sitting position with exposed outstretched left arm on a table, using an appropriate cuff, and the bladder completely encircling the arm, covering 75% of the arm between the acromion and olecranon. The ball of the stethoscope was placed over the brachial pulse, the proximal medial ante-cubital fossa. BP was measured twice in the same visit with a short rest of five to ten minutes in between, with the mean of the two recordings taken as the blood pressure level. The SBP was checked at Korotkof one and the DBP at Korotkof five. A BP greater or equal to 140/90mmHg was considered uncontrolled.

Body weight: The body weight was measured to the nearest kilogram using a bathroom scale corrected initially to zero mark was recorded while each subject was putting on minimal clothing.

The researcher ensured that the accuracy of the scale was maintained by checking the weighing scale using a standard 10kg weight after every 10 measurements.

Height: Height readings to the nearest 0.1metres were obtained from a measuring scale nailed on the walls in the clinic. Before the height was measured, the subjects were asked to remove their shoes and head coverings, and made to stand against the marked wall with their calcaneus, gluteus and occiput touching it. A ruler was used to level off the height.

Waist circumference: The waist circumference was measured with a tape measure to within one millimeter midpoint between the lowest rib and the iliac crest, with the study subject in the upright position. This was done twice and the average of the two measurements taken as waist circumference. Hip circumference (HC) was measured, with the subject standing erect, feet together and on a horizontal plane at the level of the greater trochanters (covering the widest

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circumference of the buttocks). The subjects’ weight in Kg and height in metres were used to calculate the BMI. The WHR was calculated by dividing the WC by the HC.

Quality of life tool: The QOL tool was administered to respondents either in Hausa or English, based on the preference of the subjects. It was interviewer administered by the researcher and a trained assistant in order to obtain a consistent result.

The WHO QOL is a generic instrument that has been used to measure quality of life for a wide range of medical conditions. The short version of this instrument WHOQOL-Bref which is a 26 item questionnaire was used. It is made up of domains and sub-domains. Each item of the WHOQOL- Bref has five (5) options to which the subjects responded on a 5-point scale. Each of the items had 5 responses namely very dissatisfied, dissatisfied, medium, satisfied and very satisfied which was scored as 1 -5 respectively. The WHOQOL_Bref produces a profile with four domain scores and two individually scored items about an individual’s overall perception of quality of life and health (Q1 and Q2). The four domains assessed were physical (Q3, Q4, Q10, Q15, Q16, Q17, Q18), psychological (Q5, Q6, Q7, Q11, Q19, Q 26), social relationship (Q20, Q21, Q22) and environment (Q8, Q9, Q12, Q13, Q14, Q23, Q24, Q25). Raw scores were calculated by straight forward summative scaling of the constituent item of each domain. These raw scores were then transformed to a linear 0 – 100 scale where zero (0) is the worst score possible and 100 the best score possible. Since scores for each WHOQOL-Bref domain followed a normal distribution, categorization was done around the mean + 1.96 standard deviation with good representing values greater than the mean plus one standard deviation, and poor representing values less than the mean minus one standard deviation.⁴⁶

Funding: The study was self sponsored.

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3.6 Method of Data Analysis: Data entry and analysis were done with Epi info software version