Agbo H. Abigail (MBBS, FWACP), Envuladu A. Esther (MBBS, FWACP), Hassan Zuwaira (MBBS, FMCPH), Mafwalal Bunah M. (MBBS), Zoakah A. Ibrahim (MBBS, FWACP, PGDM, MBA, PGD HIV/AIDS)
Department of Community Medicine, Faculty of Medical Sciences, University of Jos, Nigeria
Background: Health is a state of dynamic equilibrium and preventive services such as routine medical examination (RME) may promote good health by identifying disease early when effective treatment may be instituted.
Objectives: The study aimed to determine community’s knowledge of routine medical examination; willingness and challenges to RME and relationship between knowledge and willingness to perform RME.
Methodology: The study was a cross sectional descriptive study conducted among adults aged 20 years and above. P-value of <0.05 was considered statistically significant. A sample size of 384 was obtained at 95% confidence level with an estimated variance of 50% (0.5) and at desired precision of 5% (0.05 as a decimal).
Results: Of the 384 adults studied, 25% are health personnel, 62% had a good knowledge of RME. A statistically significant association (p=0.000) was established between knowledge and willingness to perform RME.
Conclusion: A RME can maintain good health by detecting disease early when treatment may be effective.
Keywords: routine medical examination, knowledge, willingness, community, challenges, socio-economic status.
Citation: Agbo, A., Envuladu, E., Hassan, Z., Mafwalal, B., & Zoakah, I. (2013). Health of the Community in Resource-Limited Countries: Awareness and Willingness to Undertake Routine Medical Examination. Open Science Repository Medicine, Online(open-access), e70081932. doi:10.7392/Medicine.70081932.html
Received: January 21, 2013.
Published: February 21, 2013.
Copyright: © 2013 Agbo, A., Envuladu, E., Hassan, Z., Mafwalal, B., & Zoakah, I. Creative Commons Attribution 3.0 Unported License.
Health as defined by the World Health Organization (WHO) is a state of complete physical, mental and social well being, and not merely the absence of disease or infirmity [1, 2]. This ‘state’ may be attained when people start appreciating health as an invaluable part of a human’s life and the absence of which may make life unbearable. The importance of health in personal life cannot be overemphasized. It has come to be regarded as a prerequisite for optimum socio-economic development of man. Good health helps in the attainment of personal ambition, favours efficiency, promotes happiness and permits people to conserve their earnings which otherwise would have been spent on treating ill-health.
Even if people realize the importance of having a good health, they often do not take this fact into account. Health is important for work, in order to perform well. Usually, people think of health only as a matter of not feeling pain or other symptoms of disease, and, sadly, they tend to put material achievements as priority in life, even at expense of their own health. Every human, regardless of class, gender, religion or other social division, needs a good health.
Health care as a right of every individual has been recognized in many countries and, as spelt out in the Universal Declaration of the Human Rights, is a fundamental right of every human being; it is essentially an individual’s responsibility. In order to protect and improve health globally, much more emphasis is needed on preventing the actual causes of important diseases as well as treating the diseases themselves. Prevention can best be achieved through concerted efforts to identify and reduce common, major risks and by taking advantage of the prevention opportunities this could improve global health much more than is generally realized . It is desirable that in life every individual should be acquainted with the essential health skills to stay healthy . It is also the individual who has to accept certain responsibilities in order to attain good health, the responsibility about diet, personal hygiene, cultivation of healthful habits, carrying out specific disease preventive measures. Specific preventive measures like performing a Routine Medical Examination (RME). RME is a needed prerequisite to assuring good health since health itself is a dynamic process . Everybody experiences health, sickness and even times of serious diseases. Lifestyle changes and health are inter-related, and in that resides the importance of RME to assess our health.
RME serves as an investigative, diagnostic and monitoring tool that enables your doctor to keep track of changes taking place in your body that may be indicative of an underlying disease or condition . RME will allow the doctor to detect and treat health concerns early enough to possibly avoid a health care crisis.
Not all diseases can possibly be prevented from occurring or manifesting, but its occurrence can be delayed long enough to allow for useful years of good health. Early detection by visiting doctors and undertaking RME might make possible to address and treat many potentially harmful conditions. As a form of preventive medicine and in order to reap the benefits of a routine examination, it should be scheduled on a yearly visit [7, 8]. A yearly visit allows detection of changes in the body. Such changes may suggest that further treatment is needed. Sometimes, all that is needed is a simple lifestyle change, other times further testing or medical treatment may be all that is required, thus an annual medical examination can be a simple way to avoid serious health conditions.
For some people, having an annual medical examination is a source of reassurance of good health. Another interpretation is as an alarm system, to show problems before they become serious. But most people still play ignorant to issues of their health, some belief it is only the sick that need to visit the hospital. But wealth, knowledge, status etc. do not translate into good health when they are not put into proper usage. Engaging a group of people in the act of routine medical examination can directly improve the overall health of the community. This study is aimed at determining the community’s knowledge of routine medical examination; the willingness and challenges to carrying out a routine medical examination.
This study was conducted in Katon Rikkos, a community in Lamingo ward, in Jos North Local Government Area (LGA) of Plateau state. It has an estimated population of 14,300 people, it is situated about one Km away from the only federal tertiary hospital in the state (Jos University Teaching Hospital); it has five private primary schools, several places of worship, five patent medicine stores, a kaolin processing company (though currently redundant in operations). Afezere, the indigenous tribe of the community, is one of the three major tribes in Jos North LGA; other tribes are also resident in the area, such as Igbo, Yoruba, Berom, Tangale and Fulani etc.
Advocacy visits were paid to the ward heads and permission to carry out the study was sought and obtained. The study was a cross sectional descriptive study which was carried out with the assistant of ten medical students who served as volunteers. One week (this duration of time to include the weekend was allotted to get information from women who mostly attend the weekly market situated three Km away from the community and adults who were mostly at work during the day) was used for the entire data collection with the use of a semi-structured interviewer administered questionnaires. The study commenced from the north end to the south end of the community. Consented adults 20 years and above residing in the community were recruited.
The questionnaires had three sections which assessed their socio-demographic characteristics, their knowledge and rate of prevalence of RME, willingness and challenges to performing RME. This was pretested in Dutse-Uku, another community about two and half Km from the study area, also in Jos North LGA, to remove any ambiguity. Statistical software EPI INFO version 3.4.3 and SPSS were used for data entry and analysis. Frequency tables and percentages were generated on socio-demographic characteristics; chi square test was used to test for association between knowledge and willingness to undertake RME and occupational status and willingness to undertake RME. P-value of <0.05 was considered statistically significant. A minimum sample size of 384 was obtained at 95% confidence level with an estimated variance of 50% (0.5) and at desired precision of 5% (0.05 as a decimal).
Three hundred and eighty-four persons were studied comprising of 123 males and 261 females. One hundred and eight persons are aged 20-29 years, accounting for 28%, the highest percentage age group. The occupation was grouped into those on a monthly wage and those without; 45% were non-monthly wage earners, while of the 55% that work and get paid at the end of the month, 48% were government employed and 7% worked in a private organization. Twenty-five percentage of the 48% government workers are health personnel. Majority (92%) practice Christianity.
Table 1: Socio-demographic characteristics of study participants
Knowledge of routine medical examination
62% knew what RME was; 59% had a good knowledge of the derivable benefits from a RME; however, 18% only knew of the frequency of carrying out the examination, while 38.3% indicated that it ought to be carried out by a physician in a reputable hospital.
Table 2: Knowledge of routine medical examination
Table 3: A relationship between knowledge and willingness to perform a RME
Willingness to perform a routine medical examination
Of the 384 study participants, 72% indicated their willingness to routinely perform a medical examination if given the opportunity.
Table 4: Challenges to routine medical examination
Table 5: A relationship between occupational status and willingness to perform a RME
This population is a growing one comprising of more youth, which is typical of a developing country. Those that had attained tertiary level of education had the highest proportion, however, average knowledge of RME was observed. This could be due to a number of factors, such as lack of the perceived importance attached to preventive care practices by the general public, ignorance of the fact that health screening at an early stage is not only meant for persons that are already symptomatic but to safeguard the occurrence of irreversible disease conditions among persons without any sign or risk of the disease. The usual expectation is that, due to the proximity of the tertiary institution or health centre to the community and with the high percent of the health personnel that reside in the area, the routine medical examination will be high in practice among members of the community; but this was contrary to the finding in this study.
A preventive practice such as a routine medical examination is a worthwhile practice that is capable of improving and sustaining the health of the individual, the family, the community in general and, indirectly, that of the nation, especially with reference to some diseases like the non-communicable ones, such as diabetes mellitus, breast cancer, hypertension etc., that have familiar tendencies of occurrence. Detecting such disease conditions early enough, when meaningful treatment can be rendered, helps not just the individual in question but the extended family in general. Also, even for the communicable ones like tuberculosis, a case detected early can significantly curtail the spread of the disease to members of the immediate family and the community, through community awareness or contact tracing.
Choosing a healthy lifestyle, knowing how to seek medical care and taking advantage of preventive measures require that people understand and use health information , but health knowledge does not automatically translate into effective use, as this was evident from an analysis of the relationship between knowledge and the willingness to practice a routine medical examination (RME), which was statistically significant. Study participants with a good knowledge of the subject matter indicated more of their willingness to conduct a RME; however, a percentage of them, though few, declined in their willingness, despite their knowledge of the benefits. But generally persons with better knowledge are better off in terms of positive decision-making; this was a concept that also came into light in a study carried out on health literacy and health outcomes where it was found that persons with limited health literacy skills are more likely to skip important preventive measures [9, 10].
Some research suggests that health literacy is a stronger predictor of health status than socioeconomic status, age or ethnic background , however this may be race or region-specific as it is an acclaimed fact in most parts of the developing countries that socio-cultural factors is a stronger predictor of health status [12-16]. Socio-economic factors is one of the reasons for poor utilization of health services, this fact was established in this study when a relationship between the occupational status and the willingness to perform a RME was accessed. Participants on a monthly salary were more willing to perform a RME than others that were not. Reasons for this contrast may likely be due to the fact that most of them are health personnel and the issue of accessibility to the health services was no longer seen as a problem. Various challenges were highlighted in this study as reasons for the failure not to practice a RME; prominent among them was cost of the examination which was perceived as been expensive, time consumption, attitude of the health workers, the bottle-necks needed to be overcome during the process and failures of their various employers to grant them permission to carry out the examination. High cost of services was also identified as a reason for poor rate of accessing preventive services from a study carried out in rural South America .
Our health is affected by a range of factors such as individual behaviour, access to health services and the environment in which we live, in addition to biology and genetics . The health of members of the community will be improved if individual that make up the community adopt healthy practices such as preventive health practices that will safeguard their health. From common reasoning, it is assumed that knowledge improves practice, this study also support this reasoning but it also highlights the fact that other reasons may contribute to non-utilization of preventive services, even among the knowledgeable people. Although service availability and resources are important at the community level, the nature and impact of challenges are also important.
A number of relevant issues were suggested by this study. For example, to what extent is information concerning routine medical examination and preventive services being disseminated by health personnel in communities when they themselves do not practice it? To what extent should relevant stake holders go to emphasize a culture of routine medical examination to reduce the prevalence of complicated disease states which could have been adequately addressed if detected earlier in the context of limited resources?
Health status maintenance through the sustenance of a routine medical examination will help to improve the health and prevent the occurrence of disease complications. Health itself operates in a dynamic state that is constantly changing and an individual ought to be abreast of this and to achieve a good health, which is a great asset not just to the individual but to the community and nation as a whole.
1. World Health Organization. WHO definition of health. FIND ONLINE
2. Awofeso N. Re-defining health. Bulletin of the World Health Organization. FIND ONLINE
3. World Health Organization. Reducing risks, promoting healthy life. World health report 2002. Page 13. FIND ONLINE
4. Essay on the importance of health. 2011[Cited 2013 Jan]. FIND ONLINE
5. World Health Organization. Principles and practice of screening for disease. Public Health Paper no.34. FIND ONLINE
6. Falcon D. Routine physical exams for women.2012 [Cited Jan 2013]. FIND ONLINE
7. U.S. Preventive Services Task Force. The Guide to Clinical Preventive Services. Rockville, MD: Agency for Healthcare Research and Quality. 2010[Cited Jan 2013]. FIND ONLINE
8. U.S. National library of Medicine. Health screening - men - age 40 – 64. Medline Plus 2012[Cited Jan 2013]. FIND ONLINE
9. Quick Guide to Health Literacy. Health literacy and health outcomes. FIND ONLINE
10. Scott TL, Gazmararian JA, Williams MV, Baker DW. Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Med Care. 2002; 40 (5): 395-404. FIND ONLINE
11. Speros C. Health literacy: concept analysis. Journal of Advanced Nursing. 2005; 50(6): 633–640. FIND ONLINE
12. World Health Organization. Commission on social determinants of health. Closing the Gap in a generation- health equity through action and the social determinants of health. 2008 [Cited Jan 2013]. FIND ONLINE
13. Moss N. Gender equity and socioeconomic inequality: a framework for the patterning of women's health; social & economic patterning of women’s health in a changing world. Social Science and Medicine. 2002; 54 (5):649–661. FIND ONLINE
14. Loppie C, Wien F. Health inequalities and social determinants of Aboriginal people’s health. 2009 [Cited Jan 2013]. FIND ONLINE
15. Low BJ, Low D. Education and Education Policy as Social Determinants of Health. Virtual Mentor. 2006; 8 (11): 756-761. FIND ONLINE
16. Feinstein L. Quantitative Estimates of the Social Benefits of Learning, 2: Health (Depression and Obesity). 2002 [Cited Jan 2013]. FIND ONLINE
17. Strickland DL, Strickland J. Barriers to preventive health services for minority households in the Rural South. Health Services Research; 23 (6): 8-9. FIND ONLINE
Abigail, A., Envuladu, E., Hassan, Z., Mafwalal, B., & Zoakah, I. (2013). Health of the Community in Resource-Limited Countries: Awareness and Willingness to Undertake Routine Medical Examination. Open Science Repository Medicine, Online(open-access), e70081932. doi:10.7392/Medicine.70081932.html
Agbo, Abigail et al. “Health of the Community in Resource-Limited Countries: Awareness and Willingness to Undertake Routine Medical Examination.” Open Science Repository Medicine Online.open-access (2013): e70081932. Web. 21 Feb. 2013.
Abigail Agbo, Esther Envuladu, Zuwaira Hassan, Bunah Mafwalal, and Ibrahim Zoakah. “Health of the Community in Resource-Limited Countries: Awareness and Willingness to Undertake Routine Medical Examination.” Open Science Repository Medicine Online, no. open-access (February 21, 2013): e70081932. http://www.open-science-repository.com/medicine-70081932.html.
Agbo, A. et al., 2013. Health of the Community in Resource-Limited Countries: Awareness and Willingness to Undertake Routine Medical Examination. Open Science Repository Medicine, Online(open-access), p.e70081932. Available at: http://www.open-science-repository.com/medicine-70081932.html.
1. A. Agbo, E. Envuladu, Z. Hassan, B. Mafwalal, I. Zoakah, Health of the Community in Resource-Limited Countries: Awareness and Willingness to Undertake Routine Medical Examination, Open Science Repository Medicine Online, e70081932 (2013).
1. Agbo, A., Envuladu, E., Hassan, Z., Mafwalal, B. & Zoakah, I. Health of the Community in Resource-Limited Countries: Awareness and Willingness to Undertake Routine Medical Examination. Open Science Repository Medicine Online, e70081932 (2013).
Research registered in the DOI resolution system as: 10.7392/Medicine.70081932.