This cross-sectional survey was conducted at a tertiary teaching hospital located in Maiduguri, Borno State, Nigeria which comprises over 500 beds. This health facility serves approximately 25 million people in Nigeria, and the adjoining countries (Cameroun, Chad and Niger republics). The facility has remained as a focal point of excellence in immunology and infectious diseases for more than three decades. Maiduguri is the largest and most commercialized city in the North-eastern geopolitical zone of Nigeria; and was also the capital city of the then North-eastern Nigeria. It is presently the capital of Borno State which occupies an area of about 50,778km2, and lies on latitude 1150N and longitude 1350E. The estimated population of Borno State based on 2006 population census is 4,098,391 and it is bordered by three countries; Niger to the North, Chad to the Northeast and Cameroun to the East .
Population for this survey was health professionals (nurses, physicians, medical laboratory scientists, pharmacists, physiotherapists and radiographers) practicing at the teaching hospital and had contact with HIV seropositives. From the database of the hospital managed by the administrative office, we took permission from the head of the administration and obtained the list of each of these professional groups by their individual staff number. From the list, there were 473 nurses, 223 physicians, 58 medical laboratory scientists (MLSs), 23 pharmacists, 18 physiotherapists and 15 radiographers who had practiced for at least one year. We used simple random sampling technique to enroll the nurses, physicians and MLSs; whilst the whole population of each of the pharmacists, physiotherapists and radiographers was used due to their respective small population sizes .
The simple random sampling technique for the enrolment of the first three health professional groups was as follows: the staff numbers of the nurses were arranged chronologically and serially; so also those of the physicians and MLSs. In essence, the oldest staff number on the list was the number one, followed by others. We selected every odd number from the chronologically arranged numbers of each aforementioned three professional groups. For instance, for the nurses, we selected 1,3,5,7,9,…,473. At the end of this sampling method, we had 237 nurses, 112 physicians and 29 MLSs, totaling 378. Total number of the pharmacists, physiotherapists and radiographers was 56. Thus, the sample size for this survey was 434. For easy administration and identification, and to avoid confusion, every staff number selected was written on each questionnaire for individual professional group. A participant was therefore administered the questionnaire that bore her/his staff number.
A researcher designed questionnaire on knowledge of effect of exercise on bone mineral density in HIV infected persons was the tool for this survey. The questionnaire was developed by the authors, and subjected to face and content validity by four professors who are experts in orthopedics and sports physiotherapy, cardiopulmonary physiotherapy, exercise physiology and infectious diseases. To ensure consistency, test re-test reliability of the instrument was administered on 20 health professionals randomly selected from the studied population, but were not part of the study. After two weeks, we re-administered the instrument on the same 20 health professionals. The computed reliability co-efficient, “r” was 0.75, signifying that the questionnaire is very strongly reliable. Section A of this questionnaire comprises both open and close-ended questions on respondents’ socio-demographic characteristics. Before completing section B of the questionnaire, every respondent was expected to tick/check YES or NO to a question, “Do you have knowledge on effect of exercise on bone mineral density in HIV- infected persons”? Those that checked YES continued with section B. Section B contains close-ended questions of 20 items, each with three domains (“Agree”, “Disagree” or “not sure” responses) for assessing the knowledge of effect of exercise on bone mineral density in HIV- infected persons. Examples of the wordings on the items are: “Exercise is an alternative therapy in management of reduced bone mineral density in HIV patients”, “Swimming is a better exercise for bone mineral density than walking”, “Progressive resistance exercises are proven not to be safe or beneficial in improving bone health in HIV population”, “Brisk walking and cycling can provide significant improvement in bone mineral density for HIV seropositives”, “Strength increases after training protocol in HIV seropositives, it may as well increase bone mineral density because of the more expressive traction of the muscles to the bones”, “Stepping or stair climbing exercise is not ideal when administering exercise for bone mineral density in HIV infection”. A correct and wrong answer to each question scores 1 and 0 respectively; hence the summative and maximum score is 20, and minimum 0. An “Agree” response to a correct statement scores 1, a “Disagree” response to a wrong statement also scores 1. Whilst an “Agree” response to a wrong statement scores 0, a “Disagree” response to a correct statement also scores 0. “Not sure” response is disregarded.
The aggregate of these scores were computed and the cumulative mean scores of the respondents in each professional group were compared with one another in the analysis. Also, the cumulative mean scores of the respondents based on their sociodemographics were compared. The higher the score, the more knowledgeable the health professionals were on the effect of exercise on bone mineral density in HIV seropositives. To determine the level of knowledge on the effect of exercise on bone mineral density in the HIV population among the health professionals, the scores were ranked as follows: 0 – 4 signifies poor knowledge; 5 – 9 indicates fair knowledge; 10 – 14 connotes good knowledge; ≥15 suggests very good knowledge.
The Research and Ethics Committee of the tertiary teaching hospital gave approval for the survey (approval number: UMTH/REC/19/425). We took permission from the Heads of Departments of each professional group enrolled for this study to enable us administer the questionnaire. We then approached and implored each Departmental secretary of the Departments to assist in issuing each copy of the questionnaire to each respondent. Written informed consent form containing the purpose, protocol, benefits and essence of the study as well as the assurance of confidentiality of the information obtained was attached to each of the questionnaire. Completing the questionnaire confirmed consent to participate in the study. We gave each secretary the corresponding number of the copies of the questionnaire based on the computed sample size. We instructed them to give each participant a questionnaire that bore her/his staff number. We also instructed the secretaries to inform the participants to drop the completed questionnaire in a medium sized carton which had an opening large enough to enter the completed questionnaire. We placed each carton at the office of the secretary of each Department. This adopted method of administering and returning the questionnaire, and the comprehensive enrolment of the 23 pharmacists, 18 physiotherapists and 15 radiographers were to guarantee anonymity and increase the response rate.
Descriptive statistics of mean, standard deviation, frequency counts and percentages summarized the sociodemographic characteristics and level of knowledge of the participants. Inferential statistic of Student t- test for independent samples analyzed the knowledge of effect of exercise on BMD in HIV-infected persons between male and female participants, and between those with and without post-graduate qualifications. One way analysis of variance (ANOVA) analyzed differences in the knowledge of effect of exercise on bone mineral density in HIV- infected persons among health professionals in other five remaining socio-demographic variables. Level of significance was set at p ≤ 0.05 using Statistical Package for the Social Sciences (SPSS) version 20.0 software (SPSS Inc. Chicago, Illinois, USA).