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NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA.

RESEARCH PROPOSAL AND TITLE REGISTRATION ASSESSMENT FORM OF PART 11 CANDIDATE

1. NAME OF CANDIDATE:-

Dr.Oshakuade Temitope Olakunle

2. FACULTY OF CANDIDATE :- Family Medicine

3. NAME OF TRAINING INSTITUTION :- Federal Medical Centre, Owo

4. ADDRESS OF TRAINING INSTITUTION:- P.M.B 1053, Owo, Ondo State

5. NAME OF SUPERVISOR:- Dr. O.O Akinboboye

6. ADDRESS OF SUPERVISOR:- Federal Medical Centre, Owo

7. NAME OF SECOND SUPERVISOR:- Dr. A.M Adebayo

8. MONTH AND YEAR PART 1 WAS PASSED: - November 2010.

9. PROPOSED EXAMINATION DATE: - May 2013.

10. PROPOSED TITLE OF PROJECT: - Perceived Family Support and Self Care

Practices among Women in Menopausal Age group Attending General Outpatient Clinic. Federal Medical Centre, Owo.

11. Phone No : 08035615474

1

13. INTRODUCTION

Menopause is a physiological event occurring with ovarian failure and marks the end of

women’s reproductive life 1 . The average age of menopause is 51 ± 3 years worldwide 2 . In 1960,

the world population of women aged 60 years and above was below 250 million, but it is

estimated that in the year 2030, 1.2 billion will be peri- or post menopausal and this total will

increase by 4.7 million every year 1 . The average woman in the developed world expects to spend

an approximately one third of her life in post menopausal state 3 .

With general increase in life expectancy many women are likely to live for more than 20 years

after menopause spending about one quarter of their lives or more in a state of estrogen

deficiency 4 .Owing to lack of estrogen, a woman may experience decrease physical and mental

well -being, that is why post menopausal woman can be considered a population at risk 5 .

Dane and Seigal medically divided menopause into three time period. These are pre-menopausal,

perimenopausal

and

postmenopausal

periods 6 .The

perimenopausal

period

is

the

period

immediately prior to the menopause at which time the endocrinological, biological and clinical

features of approaching menopause commence. Postmenopausal is the complete cessation of

menstrual periods for 12 consecutive months. However the term menopause is commonly used

for both events 6 . Natural menopause is a gradual process that occurs for most women between

ages of 45- 55 years 8 . The perimenopause (climacteric), a time of changing ovarian function,

precedes the final menses by 2 to 8 years (median of 3.8 years), some symptoms such as hot

flashes begin in the perimenopausal and increase as women progress through the menopause. 9

Menopause occurs at a point in women’s lives when other life events are taking place

simultaneously. The woman is faced with the task of adjusting to the physiological symptoms of

the personality changes, job anxiety, (career changes), maintaining an economic standard of

2

living, managing a home, adjusting to children growing or leaving home (empty nest syndrome)

etc 14

Population based studies have shown that reported health symptoms at 47 years tend to cluster

into 4 main groups: vasomotor symptoms such as hot flashes and cold night sweat, somatic

symptoms such as headaches, muscle and joint pain, psychological symptoms such as anxiety-

depression and sexual discomfort. Non specific somatic and psychological symptoms including

tiredness, irritability, insomnia, palpitations, memory or concentration difficulties, mood swings,

or depression have been commonly reported. 12

The overall health and well being of the middle-aged women has become a major public health

issue around the world. 15 For the last ten years prior to the cessation of menses, a woman

receives signal that her reproductive organs are changing, the ovary begins to show signs of

impending failure. More than 80% of women present with physical

symptoms in the years

approaching menopause with various distresses in their lives leading to a decrease in quality of

life. 15 This situation is worsened by women’s overall limited knowledge about the potential

health problems associated with climacteric and the necessary preventive measures indicated by

their low participation in screening programmes for chronic diseases coupled with their

unhealthy lifestyle (physical inactivity, low consumption of fruits, vegetables and food rich in

calcium) 16 which

impede a better overall health related quality of life. As a result of these

predicted changes in population structure, physicians are beginning to see that menopause is not

a negligible phenomenon but a major health problem. 1

Presently in Nigeria, women have higher life expectancy than men 7 . This implies that women in

their postmenopausal period make up majority of elderly population 7 . Despite the identified

problems in this age group mentioned inter alia, there is virtually no data on comprehensive

3

health care among Nigerian menopausal women especially in areas of family support, self care

practices and other health related quality of life.

Comprehensive health care is becoming an important issue however, little is known about the

complex relationship between perceived family support, self rated health and psychological

distress in mixed middle aged older primary care patients samples. 17 Self care

is

a key

component of current policies to manage long term conditions; although most people with long

term health problems care for themselves within a lay network, consultation rates for long term

undifferentiated

illness remain high. While most women seem to view menopause as a

biological event and place it within the context of their developmental milestones 18 or even

accept it as a marker of old age, where they place it as a time frame within their lifespan 19 , a

significant majority nevertheless resort to numerous prescribed and non prescribed self care

actions 20 to help see through this transition. The need and choice of these self care actions,

particularly those that are non-prescribed, however vary from region to region and women to

women depending on the education level, attitude towards menopause, psychological and

economic factors and even availability of access to medications 20 . Promotion of self care in these

individuals requires an understanding of their self care practices and need to be understood in the

context of health care pluralism. 20

Individual based care known as self care can be broadly defined as those that are practiced by the

individual and directed at relieving symptoms, maintaining health or preventing ill health. 21

Rogers and Hay 22 view self care activity as a continuum with those efforts made solely by the

individual at one end and those shared with professionals at the other. The interactions between

sectors of care, particularly self care/professional care (notably primary care) interface are

increasingly demanding attention in research. 23 Studies have predominantly investigated self

4

management interventions relating to specific diseases or long term conditions particularly

diabetes, asthma, and arthritis 23 . In contrast, self care practices adopted by people with less well

defined health problems are little understood, despite the prevalence of such problems and the

challenges they pose to the General Practitioners. 24

Family support is an important factor in conceptualizing primary health care patient problems 17 .

Numerous

examples of how the family system determines the course of chronic illness have

been influential in the development of collaborative medical care. 17 By understanding how the

family influence health, the Family Physician has the opportunity to anticipate and reduce the

adverse effects of family stress and use the family as a source of care of the patients. Family

oriented approach to health care is based on the bio-psysocial model that emphasizes the

relationship among biologic, interpersonal and social factors in health 25 .

The beneficial effect of family support in overall health promotion and chronic illness are

reviewed and how to use family as a valuable resource and source of support in the care of the

patient have been discussed. Understanding how family can influence health can assist the

Physician in working more effectively with patients and families.

14. STATEMENT OF THE PROBLEM

Climacteric stage women experience significant biological, psychological and social changes 30 .

With the demographic changes being observed in the growing number of climacteric stage

women, it is important to improve their knowledge about the climacteric stage and its potential

associated problems, encourage their participation in screening programmes and promote the

acquisition of healthy life style. 30

5

A need arises when one sees a difference between the situation considered as optimal and the

actual observed situation, the difference to be is then the need 30 . In the health field, the felt need

relates to the perception people have about their health problems or whatever they want to

receive from the health services. There exist a need that people do not perceive, but it must be

satisfied to maintain, restore or improve their health 30 .

Traditionally, climacteric stage women seek medical attention when they perceive health

problems attributed to this stage such as severe climacteric symptoms, osteoporosis related

fractures, symptoms or complication of chronic diseases. Regarding the unfelt need, most

women do not perceive the need to prevent such health problems early 16 .These situations result

in delayed health seeking behaviors for these problems which in turn represent a significant

burden for health care system and for the society due to high health cost of health care, decreased

quality of life, and premature death 16 .

A vast majority of Nigerian women have limited knowledge about the menopausal period 10 .

Recent community based studies 31 have revealed that most menopausal symptoms are indeed

prevalent among Nigerian women but because of cultural practices that endanger positive

attitude to menopause in some Nigeria communities, 31 women with mild menopausal symptoms

are able to cope with the symptoms without seeking for medical treatment however women with

moderate and severe menopausal symptoms consider them important health

treatment for these symptoms. 31

concern and seek

Documenting women’s use of self care actions will help better understanding of woman’s

transition through this phase of her life, in addition it may serve as a platform to detect gaps in

the perceived family support and self care practices among this group of women which may

6

provide an opportunity for further studies on the role of family support and self care practices

since very little information is available on this issue in Nigeria.

15. AIM AND OBJECTIVES

Aim:

To investigate the role of perceived family support and self care practices among women in

menopausal age group attending the General Outpatient (GOP) clinic of Federal Medical Centre,

Owo, Ondo State.

Objectives:

1. To assess the knowledge and attitude to menopause among women aged 40-60 years

attending GOP clinic.

2. To determine the prevalence and pattern of menopause related symptoms among women

aged 40-60 years attending GOP clinic.

3. Identify the perceived self care practices for somatic / vasomotor symptoms and self rated

health among women aged 40-60 years attending GOP clinic FMC Owo.

4. Explore the role of family support among women in the menopausal age group attending

GOP clinic, FMC.Owo.

16. PROPOSED METHODOLOGY

Study location

The study will be conducted at General Outpatient Clinic, Federal medical Centre, Owo. Federal

Medical Owo is a government own tertiary hospital in Ondo- State, South Western Nigeria and

has one of the largest patients attendance in the state. The hospital offers services in different

specialties such as Family Medicine, Internal Medicine, Surgery, Obstetrics and Gynecology,

7

Community Health, Dentistry as well as Ophthalmology. Others include Laboratory Medicine,

Radiology, and Physiotherapy. The hospital serves as primary, secondary and tertiary health care

centre for people in states like Ondo, Ekiti, Edo, Kogi and Osun.

STUDY DESIGN

A cross sectional study will be used to assess the role of family support and the self care

practices in women with menopausal related symptoms attending General Outpatient Clinic

Federal Medical Centre, Owo.

ETHICAL CLEARANCE AND CONSENT

Ethical clearance shall be obtained from the hospital’s Health Research Ethics Committe and

written informed consent from each subject shall be obtained.

Study Population

Female patients aged 40 60 years old that attend GOP clinic, FMC, Owo within the study

period. The study is expected to be conducted over a period of three months.

Inclusion criteria:-

1. Women that are aged 40 60 years old attending General Outpatient clinic.

Exclusion Criteria:-

1. Failure to give consent

2. Acutely and critically ill patients at the time of interview

3. Pregnant and breastfeeding mothers

4. Those on highly active antiretroviral therapy (HAART)

Sample Size Determination

The required sample size will be calculated by using the formula for descriptive study

n = z 2 pq/d 2

8

Where n= the desired minimum sample size

z= standard normal deviate at 5% level of significance = 1.96

p = the proportion of the target population estimated to have a particular characteristics

(percentage of menopausal women with good family support =50% 11 )

q =1.0 p

d= degree of accuracy described usually set at 0.05 level

n =

=

1.96 2 x0.50 (1 - 0.50)

(0.05) 2

0.9411

0.0025 = 384.16

= 384 female patients

In order to accommodate for 5% attrition

= 5/100 x 384

= 19.2

The total sample size = 404

Sampling Method

female patients.

Systematic random sampling technique will be used to recruit subjects for this study. On the

average, eight hundred and twenty five (825) women attend General Outpatient clinic in one

month among whom an average of 412 (50%) are within age 40-60 years.

Using systematic random sampling, a sampling interval of 3 is obtained as derived below:

Sampling interval = number of women aged 40-60 years x duration of study / minimum sample

size

= 412 x 3

404

9

Therefore, every third patient that meets the inclusion criteria will be recruited for this study.

DATA COLLECTION AND PROCEDURE:

Data collection and instrument:

A semi-structured interviewer administered questionnaire will be used for data collection. The

questionnaire is divided into various sections based on the objectives. These are socio-

demographic characteristics, house-hold structure and characteristics, knowledge and perception

of menopause, personal and health screening habits, self care practices, family support and

health-related quality of life (QOL) measure. Standardized questionnaires (Family APGAR,

Women health questionnaire and self care questionnaire) will be used to measure family support,

menopause related symptoms and self care actions.

Family APGAR (family Adaptation, Partnership, Growth, Affection, and Resolve.) - A 5 item

measure of perceived family support that was designed as an assessment tool for Physician 26 .The

APGAR was chosen for this study because it measures a theoretically important construct in a

brief and easily administrated format. Family physicians trained in other methods of assessment

e.g. (the McMaster model of family functioning) are unlikely to use them in the actual practice 27

and reported that they are too busy to use such a protracted and costly approach.

The APGAR has distinguished between patients with and without family distress 28 with a lower

scores indicating less satisfying perceived family support. The participant would respond to each

item using a 3 points rating scale ranging from 0 (hardly ever to 2 (almost always)

Women Health Questionnaire (WHQ) - This is a population specific questionnaire that is

applied to women only.WHQ is one of the most frequently utilized measure in the assessment of

QOL in middle-aged women 29 . Originally designed to assess symptom perception during the

menopause and for older post-menopausal women, it is within this range (45 65 years) that

10

hormone mediated changes such as vasomotor symptoms and vaginal dryness, menstrual

changes and age related bodily changes such as changes in sleep pattern, sexual behavior and

physical health are prevalent. 29 The revised 23 item questionnaire investigating 6 dimensions

(Anxiety/Depressed mood, Well being, Somatic symptoms, Memory/Concentration, Vasomotor

symptoms, and Sleep problems) of physical and emotional health rated on four point scale will

be used for this study.

Self care and Routine Health screening - The list of screening would be adapted from health

screening guide for menopausal women 34 . This includes breast cancer screening, cervical cancer

screening or Pap test, fasting lipid profile/cholesterol, blood glucose, and thyroid function test.

The use of screening services will be estimated as the sum of the number of screening services

that the woman used, divided by the total number of screening services recommended according

to Mexican Institute of Social Security (IMSS) regulations and multiplied by 100 30

Women’s knowledge and perception of menopause - Women’s knowledge and perception of

menopause will be estimated with a questionnaire developed ex profeso 30 . The questionnaire

consists of 9 items that assess current menstrual status, ideas and feelings about menopause,

source of information and menopause related symptoms.

The following clinical parameters will be measured: blood pressure, weight, height and basal

metabolic index (BMI).

Accoson mercury sphygmomanometer This will be used by a medical officer, to take resting

blood pressure (BP) of subjects. The diastolic and systolic blood pressures will be taken and

graded according to the Joint National Committee on Detection, Evaluation and Treatment of

Hypertension (JNC VII).

11

Detecto (England) weight and height scale This will be used to measure both the weight (Kg)

and height (m) of the subject. The scale will be adjusted before each use to avoid parallel errors

these measurements will be used to calculate the BMI of the patient to detect those that are

underweight and obese.

Trained assistants will be used to carry out the height and weight measurement and data

collection

The research in term of cost will be self sponsored.

DATA ANALYSIS

The data obtained will be analysed using the statistical package for social sciences (SPSS) for

windows evaluation version 18 (SPSS 18, Chicago Illinois). Descriptive data will be presented

using tables, graphs and charts while association between variables will be assessed with chi

square for qualitative variables and t-test as well as correlation coefficient for quantitative

variables as appropriate at 5% level of significance.

17. RELEVANCE AND JUSTIFICATION

There is paucity of information in the area of family support and self care practices in

menopausal

women

in

African

setting

including

Nigeria.

Studies

have

predominantly

investigated self management interventions relating to specific diseases or long term conditions

particularly hypertension, diabetes, asthma, arthritis, but none have addressed areas concerning

family support and self care in menopausal women in Nigeria where there still exist a strong

adherence to traditional and cultural practices and where the way of life places a lot of demand

on the women in the running of the household. This study is therefore aimed to achieve an

12

understanding of the role of family support, self care practices and health related quality of life in

women with menopause related symptoms attending the General Outpatient (GOP) clinic of

Federal Medical Centre Owo, focusing on biosocial aspect of family support, self care practices,

self rated health and common non specific symptoms that are difficult to treat with medical

interventions but which are amenable to self care practices and routine screening. This could

enable hypothesis generation for further research and to inform the development of methods of

supporting women with menopause related symptoms in our environment.

18. LIMITATION/CONSTRAINT

This cross-sectional study that involves women within the age range of 40-60 years may have to

be sorted by the medical records which may lead to some errors in recruiting the subjects.

However, the estimated sample size has accommodated 5% attrition.

13

19. REFERENCES

1. Jin Yong Lee, Chang Suk Suh. The attitudes of post menopausal women towards

hormone replacement therapy HRT and effects of HRT on lipid profiles. Proceedings of

the first consensus meeting on menopause in east Asian region 1997: May 26-30.

Geneva, Switzerland.

2. Bhavaanns BR, Shhiker RC . Menopausal Hormone Replacement Therapy. J obstetric/

Gynaecol 2005; 27(2): 137-62.

3. Avis NE. Women’s perception of menopause. Euro Menopause J 1996;3:80-4.

4. Bener A, Rizk DE , Shaheen H, MIcAllet R, Osman N, Dunn EV. Measurement of life

satisfaction during menopause in an Arabian Gulf country climacteric 2000; 3: 43 -9.

5. Fuh JL, Wang SJ,Lusr Juan KD. Quality of life and menopause transition for middle

aged women in Kinsmen Island. Quality of life Res 2003;12: 533-61.

6. Doubova SV , Flores-Hernandez S, Rodriquez AL, Peres -Cuevas R . Quality of care

and health related quality of life of climacteric stage women cared for in the family

medicine clinics. Health quality of life outcomes 2010; 8: 20.

7. Saka MJ, Saidiu R, Jimoh A, Akande T et al. Behavioral pattern of menopausal Nigeria

women. Ann Trop Med Public Health 2012;5: 74-9.

8. Greendaleble GA, Lee NP, Arriola ER. The Menopause. Lancet 1999; 286: 571-80

9. Hardly R, Kuh D. Changes in psychological and vasomotor symptom reporting during

menopause. soc sci med 2002; 55: 1975-88.

10. Olawoye JE, Aderibigbe TO, Olarinde S. Reproductive Health issue for Nigerian Women

in Menopause. Gender and Behaviour 2003; 1: 1-15

14

11.

Sushmitha RK, Judith AN. Determining bio-psychosocial wellbeing and family support

of menopausal women in selected hospitals of Udipi Distric, Karnataka: International

Journal of Nursing Education 2011; 3(2):114-117.

12. Kenemans P. Menopause, HRT and Menopausal symptom. J epidermal biostart 1999; 4:

141-6.

13. Alexander J. Neurobehavioral impact of menopause on mood. Expert Rev Neurother.

2007 Nov;7(11 Suppl):S81-91.

14. Utian WH. Ovarian function, therapy Oriented definitions of menopause and

climacteric experimental gerontology 1994; 29(3-4): 245-251.

15. Whelan TJ, Goss PE, Ingle NJ, Tu DS, Pritchard K, et al. Assessment of quality of life in

MA.17: A randomized, placebo controlled trial of tetrozole after 5 years of tamoxifen in

postmenopausal women. clin onclo 2005; 23:6931-40.

16. Doubaou SV, FloresHernandez, Rodriquez Aquila et al. Quality of care and health

related quality of life of climacteric stage woman cared for in family medicine clinics.

Health Qual life outcomes 2010; 8: 20.

17. Annmarie Cano, Douglas JS, Robert PS et al .Family support, Self rated Health and

psychological distress. Primary Care Companion J Clin Psychiatry 2003;5(3) 111-117.

18. George T. Menopause; Some interpretation of the result of a study among a non western

group. Maturitas 1988; 109(2):109 16.

19. Lind AL, Hoffman M, Hammer M, kejellgree K. Women conception of the menopausal

transition- A qualitative study. J clin nursing 2007; 16: 509- 17.

15

20.

Gupta S, Forbes N, Kirkman R. Attitudes to menopause and hormone replacement therapy

among Asian and Caucasian women general practitioners. Maturias 2001; 39:16 169- 75.

21. Barofsky I: Compliance, adherence and therapeutic alliance. Steps in the development of

self .Soc sci Med 1978; 12: 369-76.

22. Rogers AH. Self care and access to health care. Opportunities for improving access to care.

NNSE Anglia and oxford Region Milton Leynes 1998;1471-2296.

23. Stevenson FA, Britten N, Barry CA et al. Self treatment and its discussions in medical

consultation. How is medical consultation pluralism managed in practice? Soc sci med 2003;

57(3): 513 -27.

24. Aggarwd VR, Mc Beth J, Zakrzewska JM et al. The epidemiology of chronic syndromes that

are frequently unexplained: do they have a common associated factor. Oxford Journals 2012;

41(3) 467-476.

25. Jane H, Bray and Thomas L Campbell. The family influence on health; Textbook of family

medicine 7 th edition; page 25-26.

26. Smilkstein G. The family APGAR: A proposal for a family function test and its use by

physicians. Fam Prac 1978;6:1231-1239.

27. Bishop DS, Epstein NB, Glibert R, et al. Training family physicians to treat families:

unexpected compliance problems. Fam Sys Med 1984;2: 380-386.

28. Good MJD, Smilkstein G, Good BJ, et al. The family APGAR index: a study of construct

validity. J Fam Pract 1979:8:577-582.

16

29 Hunter M. The Women's Health Questionnaire: A Measure of Mid-Aged Women's

Perceptions of Their Emotional and Physical Health. Psychology and Health 1992;7:45-54.

30. Svetlana VD, Patricia Esoinisa, Sergio P et al. Integrative health care model climacteric

stage women. BMC women health 2011; 11:6.

31 Peter Nkwo, Hyacinth Onah. Positive attitude to menopause and improved quality of life

among Igbo women in Nigeria. International journal of Gynecology and Obstetrics 2008;103

(1):71-72.

32 Agwu UM, Omeora OUJ ,Ejikeme BN: Patterns of menopausal symptoms and adaptive

ability in rural population in south east Nigeria. Journal of obstetrics and gynecology 2008;

28(2):217-21.

33 HardipKaur Dhilon, Nik Mohd Zaki Nik Mahmood, Harbindarjeet Singh. Documentation of

self care actions taken for somatic complaints by postmenopausal Malay women living in

Kelantan Malasia. Maruritas 2007; 58(3): 241-8.

34 Juian Uffner. Menopausal Screening Guide for Menopausal Women. Women Health Source,

www.mainline health.org

17

Appendix I

Application supported by:

a) Head of Department: Name: Dr (Mrs.) O.E. Adeleke.

Year of Fellowship: 2003.

Signature and Date ……………………

b) Supervisor: Name: Dr O.O. Akinboboye

Year of Fellowship: 1991

Signature and Date

………………………

c) Second Supervisor: Name: Dr A.M. Adebayo (FWACP)

Year of Fellowship: 2010

Signature and Date

………………………

d) Name of Candidate: Oshakuade, Temitope Olakunle.

For Official Use Only

Signature and Date

…………………………

a) Date of receipt of proposal

……

b) Date forwarded to Chief Examiner or designated assessor

………

c) Date returned by Chief Examiner or designated assessor

………

d) Approved by Chief Examiner

(Yes/No)

………

e) If not approved, objections must be communicated to the candidate.

Date approval/objections communicated.

18

………

Appendix II

RESEARCH QUESTIONNAIRE ON THE PERCEIVED FAMILY SUPPORT AND SELF CARE PRACTICES AMONG WOMEN IN MENOPAUSAL AGE GROUP ATTENDING GOPD, FMC .OWO

Dear Sir /Madam

This study is designed to determine the role of family support and self care

practices as women transit through their reproductive years.

Your cooperation is needed to truthfully answer the questions below. Any

information provided will be kept in strict confidence and will be used for

academic purposes only. Answering these questions should take only 15-20

minutes of your time. Thank you.

Dr. Oshakuade T.O

Investigator

Identification number……………

19

Serial No

QUESTIONNAIRE Perceived Family support and Self Care Practices among Women in menopausal age group attending GOP, FMC. Owo This is an interviewer administered questionnaire and the information requested in it is intended for research purposes only. The following questions are concerned with you, your family and your medical condition. Please answer all questions.

Section A: Socio-demographic data

 

*code- for data entering

 

Questions

Responses

Co

de

01

Age , (last birthday)

 

02

 

Sex

M

1

 

F

2

03

What is your highest level of Education?

no formal education primary secondary post primary

 

1

2

3

 

4

04

What is the highest level of schooling completed by your spouse

no formal education primary secondary post secondary

 

1

2

 

3

4

05

 

Occupation- patient

unemployed petty trader/laborers/messenger Junior school teacher/driver/artisan senior school teacher/ intermediate grade public servant senior public servant/ professional/manager

1

 

2

3

4

5

06

 

Occupation partner

unemployed petty trader/laborers/messenger Junior school teacher/driver/artisan senior school teacher/ intermediate grade public servant senior public servant/ professional/manager

1

 

2

3

4

5

07

 

Ethnicity.

Hausa

1

.

Yoruba

2

 

Igbo

3

others

4

.Section B: Household Structure And Characteristics

 
 

Which of these best described your marital status?

never married

1

08

married

2

divorced

3

separated

4

widowed

5

09

If married, what type of marriage;

monogamous

1

polygamous

2

10

If polygamous, number of wives.

   

20

11 How many people eat from the same pot in your house total= male= adult
11
How many people eat from the same pot in your
house
total=
male=
adult
children
female= adult
children
12
Perceived head of the family
myself (patient)
my spouse/partner
others pls specify…
1
2
3
13
How much did all source of household income provide for your
house hold in the last 4 weeks?
N
14
In the last 4 weeks how much did your house hold spend in total
N
15
In the last 4 weeks how much did your household spend on food
items
N
Section C : Self reported and self rated health
16
What medical condition(s) are you
currently being treated for in the
past 3 months
1.hypertension 2.DM 3.difficulty with breathing 4.cough 5.fever
6.dizziness 7.body pain 8 back pain 9.stomach pain,10 easy fatigue
11vaginal itching/discharge ,12 urinary discomfort 13. palpitation
14.chest pain 15.loose stool,16.headache, others pls specify………
17
How do you consider or rate your health in the past 3
months?
Good
Fair
Poor
I don’t know
1
2
3
4
Section D: Gynecological data
18
How would you describe your current
menstrual status?
Regular (menstruate monthly for the past 12 months)
Irregular menses within the past 12 months
No menses for the past 12 months
1
2
3
19
If irregular or no menstrual period which
of the following reason apply to you?
Pregnancy (confirmed)
Family planning
Previous removal of womb
menopausal
I don’t know
Others ,Pls specify……
1
2
3
4
5
6
20
Have you had any Gynaecological
Procedure/Operation?
Yes
1
No
2
21.
If yes to question 20 ,What was done?
1.Uterine curettage
2. Removal of fibroid
3
IUCD-cuT
4. removal of womb
5
Others pls specify
Section E: Knowledge and Symptoms of Menopause
22
Have you ever heard of
menopause
Yes
1
2
No

21

23

If yes to Q22, What is your main source of information

Books/magazine Internet Friends/relatives TV Healthcare providers Others pls specify

 

1

 

2

 

3

4

5

6

24

What do you understand by menopause?

Beginning of menses Cessation of menses Heavy vaginal bleeding Lower abdominal pain Other Pls specify…

 

1

2

 

3

4

5

25

What is your feeling about menopause

No more periods and no more worry about contraception. Menopause marks a new life phase. Loss of fertility and loss of youthful self Beginning of old age for women A taboo Others please specify………

1

2

 

3

4

5

6

26

Do you know some symptoms associated with menopause?

 

Yes

1

No

2

27

If yes to Q26 above ,Please tick as appropriate

1.

hot flashes

 

7.

Vaginal dryness

 

2.

inability to sleep

8.

Easy fatigue

 

3.

depression

9.

Reduced libido

4.

irritability

10.

Crawling sensation

5.

night sweats

11.

pain on urination

6

.Muscle/joint pain

12.

Others pls specify

28

Do you have any of the following symptom(s) within the past 3months Please tick as appropriate

1.

hot flashes

 

7.

Vaginal dryness

 

2.

inability to sleep

8.

Easy fatigue

3.

depression

9.

Reduced libido

 

4.

irritability

10.

Crawling sensation

5.

night sweats

11.

Pain on urination

6

.Muscle/joint pain

 

Section F:

PERSONAL HABITS AND HEALTH SCREENING

 

29

Did you examined your breast yourself in the last 1 month

 

Yes

 

1

 

No

2

30

If yes to Q 29,

why?

pain

1

 

discomfort/discharge

 

2

lump

3

others

4

31

Have you examined your breast with a physician in the last 1 year?

 

yes

1

no

2

32

If yes to Q31 ,

what was your reason?

   

pain

1

 

discomfort

 

2

 

lump

3

others

 

4

33

Have you ever heard of Cervical Pap smear?

 

Yes

1

 

No

2

34

If yes to Q33, have you done this test in the last 3 years

 

Yes

1

 

No

2

22

35

Have you ever heard of Mammogram/breast x ray?

 

Yes

 

1

 

No

2

36

If yes to Q35, have you done this test before?

 

Yes

 

1

 

No

2

37

Have you ever heard of Blood sugar test/ diabetes:

 

Yes

 

1

 

No

2

38

If yes to Q37, have you done this test in the last 3 years

 

yes

 

1

 

No

2

39

Have you ever heard of Cholesterol or Fasting lipids?

 

Yes

 

1

 

No

2

40

If yes Q39, have you done this test in the last 3years

 

Yes

 

1

 

No

2

41

Have you ever heard of been overweight?

 

Yes

1

No

2

42

If yes to Q41, have you voluntarily weighed yourself in the last 1 year

Yes

1

No

2

43

Have you ever heard high blood pressure/hypertension

 

Yes

1

 

No

2

44

If yes to Q43, have you voluntarily done this test in the last 1 year

Yes

1

No

2

Section G : Life Style And Habits Please tick as appropriate

   

45

Do you smoke tobacco?

Yes

1

No

2

46

If yes to Q45,how many sticks per day

1-5

1

5-10

2

>10

3

47

Do you drink alcohol orbeer?

Yes

1

no

2

48

If yes to Q47, how many bottles per day

Occasional

Rarely or <once /week 1-14 drinks /week > 14 drinks /week

1

Moderate

2

 

Heavy

3

49

Are you on any special diet

Yes

1

2

 

no

 

If yes to Q49, which one

fruits and vegetables Reduce yam and cassava intake Reduce salt intake Others pls specify…

1

2

50

 

3

4

51

How often do you exercise

At least three times a week Occasionally Rarely Never

1

2

 

3

52

What activity(ices)

Brisk walking Jogging Other please specify

1

2

 

3

53

For how long?

1-10min

1

10-20min

2

20-30min

3

30-1hr

4

23

Section H: Self care practices for self reported somatic /vasomotor symptoms

54

Backache

1

absent,

1

no action,

 

2

mild,

2

taking HRT,

3

moderate,

3

taking traditional/alternative medicine……

4

severe

4

self medication/OTC drugs…………………. prescribed medication…….

 

5

6

if any other pls state

 

55

Musculoskeletal aches and pains

1

absent,

1

no action,

 

2

mild,

2

taking HRT,

 

3

moderate,

3

taking traditional/alternative medicine………

4

severe

4

self medication/OTC drugs………………….

 

5

prescribed medication………

 

6

if any other pls state

56

Hot flashes

1

absent,

1

no action,

 

2

mild,

2

taking HRT,

3

moderate

3

taking traditional/alternative meds ……………….

4

severe

4

self medication/OTC drugs………………….

 

5

prescribed medication

 

6

if any other pls state

57

Tiredness

1

absent,

1

no action,

 

2

mild,

2

taking HRT,

3

moderate

3

taking traditional/alternative meds…………

4

severe

4

self medication/OTC drugs………………….

 

5

prescribed medication……….

 

6

if any other pls state

58

Decrease level of concentration

1

absent,

1

no action,

 

2

mild,

2

taking HRT,

 

3

moderate

3

taking traditional/alternative meds………

4

severe

4

self medication/OTC drugs………………….

 

5

prescribed medication……….

 

6

if any other pls state

Section I:

Family APGAR

 

Please explain how you feel about your family

 

59

am satisfied that I can turn to my family for help when something is troubling me.

I

Almost always some of the time never

1

2

 

3

60

am satisfied with the way my family talks over things with me and shares problems with me

I

 

Almost always some of the time never

1

2

 

3

61

I

am satisfied that my family accepts and supports

Almost always some of the time never

1

my wishes to take on new activities or directions

2

3

62

am satisfied with the way my family expresses affection and responds to my emotions such as anger, sorrow or love

I

 

Almost always some of the time never

1

2

3

63

am satisfied with the way my family and I share time together

I

Almost always some of the time Never

1

2

 

3

24

Section J:

Women Health Questionnaire© Professor Myra Hunter, King’s College London, UK

Please indicate how you are feeling now, or how you have been feeling THE LAST FEW DAYS, by putting a tick in the correct box in the answer to each of the following items :

Yes,

definitely

Yes,

sometimes

No,

not much

No, not at all

64

I wake early and then sleep badly for the rest of the night

65.

I get very frightened or panic feelings for apparently no reason at all

66.

I feel miserable and sad

67.

I feel anxious when I go out of the house on my own

68.

I have lost interest in things

69.

I get palpitations or a sensation of "butterflies" in my stomach or chest

70.

I still enjoy the things I used to

71.

I feel life is not worth living

72.

I feel tense or "wound up"

73.

I have a good appetite

74.

I have headaches

 

75.

I feel more tired than usual

76.

I

have dizzy spells

77.

I suffer from backache or pain in my limbs

78.

I have hot flushes

 

79.

I am more clumsy than usual

80.

I feel sick or nauseous

81.

I have feelings of well-being

82.

I suffer from night sweats

83.

I have difficulty in getting off to sleep

84.

I

feel physically

attractive

85.

I have difficulty in concentrating

86.

My memory is poor

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

Section k: Physical Examination

87

BP (mmHg)……………

88

Weight (kg)

89

Height (m)……………

90

BMI {wt/h 2 }

91

Last menstrual period (weeks/month/years)

25

Appendix III

SUBJECT INFORMATION SHEET

1. My name is Oshakuade,Temitope Olakunle.

2. Participation in this study is voluntary and non-participation attracts no penalty or loss

of benefits due to subjects.

3. Subject is free to withdraw at anytime with no penalty or loss of benefit

4. The research is a cross sectional study on Perceived Family Support And Self Care

Practices Among Women in Menopausal Age Group Attending General Outpatient

Clinic, Federal Medical Centre, Owo. The study will span three months and subjects

are

expected

to

truthfully answer

questions

in

the

administered

questionnaire.

Information obtained will be treated with utmost confidentiality.

5. There is no risk associated with taking part in this study

6. I can be reached at the department of Family Medicine, Federal Medical Centre, Owo

and on phone number 0803-561-5474.

26

Appendix IV

I

INFORMED CONSENT FORM

of

hereby agree to participate

in this study on Perceived Family Support And Self Care Practices Among Women in

Menopausal Age Group Attending General Outpatient Clinic, Federal Medical Centre, Owo.

I confirm that I have read the patient information sheet and/or the details of the study have

been explained to me. I have had opportunity to ask questions about the study and to receive

satisfactory answers to my questions.

I understand that the data from this study will be secured against unauthorized use and that I

will not be identifiable from published results.

Signature/thumb print of participant

Date

Signature of interviewer:

Date

27