Nigerian Health Research Articles

A comprehensive analysis of stroke admissions at a rural Nigerian tertiary health facility: Insights from a single-center study.

This research intended to examine the demographic and clinical attributes of stroke admissions in a rural Nigerian hospital. A retrospective analysis of stroke admissions was conducted over 1 year. All necessary data were obtained from patients' records and SPSS was employed for data analysis. P < 0.05 was deemed significant. There were 52 stroke cases, accounting for 5.9% of medical admissions. The patients' mean age was 62.81 ± 12.71 years, while females constituted 51.9% of cases. Common risk factors included hypertension (76.9%), hyperlipidemia (38.5%), alcohol (26.9%), and diabetes mellitus (26.9%). Clinical manifestations included hemiparesis/plegia (84.6%), altered consciousness (63.5%), slurred speech (61.5%), cranial nerve deficit (61.5%), aphasia (42.3%), and headache (34.6%). Ischemic stroke (71.2%) predominated over hemorrhagic stroke (28.8%). The average hospitalization duration was 17.62 ± 8.91 days, and the mean onset to arrival time was 121.31 ± 136.06 h. Discharge and mortality rates were 82.7% and 13.5%, respectively. The association between stroke subtypes and mortality was significant (P = 0.001). Stroke constitutes a significant portion of medical admissions in Nigeria, with ischemic stroke being more prevalent. High mortality rates underscore the urgent need to manage risk factors to prevent stroke.

Problems and Prospects of the Nigerian Health Care System

Health care in Nigeria is continually faced with the issue of high demand as its population increases. This demand has consistently met with low accessibility and supply, which is rather devastating to the health system. This study aims to investigate the problems and prospects of the Nigerian health care systems, the extent to which the problem affects the population and what could be done to improve the situation. Secondary data were adopted to generate information relevant to undertake a comparison based data collected from 2013 till 2020. The secondary data were sourced from accessible academic publications, research works and journal from various field of study. The challenges of the Nigerian health sector are numerous and over time have increased due to the increasing population and failure in government policy implementations. Other issues include the reduction in health care sector budget despite the upsurge in insurgency and health hazards such as the COVID-19 pandemic and strike action by health professional over government inability to meet their demands. Increment and more incentives should be given to the medical professionals as a matter of urgency.

Digital Health Technology Awareness and Attitude among Nigerian Health Care Workers during the COVID-19 Pandemic

Digital Health Technology Awareness and Attitude among Nigerian Health Care Workers during the COVID-19 Pandemic

Effects of Armed Conflicts and Insecurity on the Mental Health of Nigerians

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Public Health Activities: Evaluation of Community Pharmacists’ Attitude, Practice and Barriers in a Nigerian Southwestern State

The Nigerian health system continues to face double burden of communicable and noncommunicable diseases. To meet the country’s health needs, the number of healthcare professionals participating in public health activities must be increased. The purpose of this study was to assess the attitudes, practices and barriers to rendering public health services among community pharmacists in a southwestern Nigerian state. We used a pretested self-administered questionnaire to collect data on 120 community pharmacists’ sociodemographic characteristics, practices, attitudes and barriers to providing public health services. Participating pharmacists must have at least one year of experience working in a community pharmacy. Data were summarised descriptively using IBM SPSS (version 23.0). Females’ respondents were (n = 69, 57.5%) and (n = 82, 68.3%) pharmacists had 1 year– 5 years’ experience. Most (n = 116, 96.7%) of the respondents agreed that pharmacists should be involved in public health activities, and (n = 106, 88.3%) respondents disagreed that public health activities should be carried out only by doctors and nurses. Overall (n = 89, 74.0%) of the respondents had positive attitude to public health activities (score ≥ 80%) and majority of the community pharmacists had been practicing public health activities. Insufficient time (n = 65, 54.2%) and lack of financial capital to implement changes (n = 84, 70.0%) were identified as prominent barriers that hindered community pharmacists from rendering public health services. Community pharmacists had positive attitude towards the practice of public health activities. However, further studies should emphasise on how to overcome barriers preventing their involvement in public health activities. Providing incentives for public health services rendered could increase community pharmacists’ involvement in public health activities.

Provider-identified barriers to performance at seven Nigerian accident & emergency units: A cross-sectional study.

Nigeria hosts much of Africa's morbidity and mortality from emergency medical conditions. We surveyed providers at seven Nigerian Accident & Emergency (A&E) units about (i) their unit's ability to manage six major types of emergency medical condition (sentinel conditions) and (ii) barriers to performing key functions (signal functions) to manage sentinel conditions. Here, we present our analysis of provider-reported barriers to signal function performance. 503 Health Providers at 7 A&E units, across 7 states, were surveyed using a modified African Federation of Emergency Medicine (AFEM) Emergency Care Assessment Tool (ECAT). Providers indicating suboptimal performance ascribed this performance to any of eight multiple-choice barriers [infrastructural issues, absent and broken equipment, inadequate training, inadequate personnel, requirement of out-of-pocket payment, non-indication of that signal function for the sentinel condition, and hospital-specific policies barring signal function performance] or an open-ended "other" response. The average number of endorsements for each barrier was obtained for each sentinel condition. Differences in barrier endorsement were compared across site, barrier type and sentinel condition using a three-way ANOVA test. Open-ended responses were evaluated using inductive thematic analysis. Sentinel conditions were Shock, Respiratory Failure, Altered Mental Status, Pain, Trauma, and Maternal & Child Health. Study sites were the University of Calabar Teaching Hospital, the Lagos University Teaching Hospital, the Federal Medical Center, Katsina, the National Hospital Abuja, the Federal Teaching Hospital Gombe, the University of Ilorin Teaching Hospital (Kwara), and the Federal Medical Center Owerri (Imo). Barrier distribution varied widely by study site. Just three study sites shared any one barrier to signal function performance as their most common. The two barriers most commonly endorsed were (i) non-indication of, and (ii) insufficient infrastructure to perform signal functions. A three-way ANOVA test found significant differences in barrier endorsement by barrier type, study site and sentinel condition (p<0.05). Thematic analysis of open-ended responses highlighted (i) considerations disfavoring signal function performance and (ii) lack of experience with signal functions as barriers to signal function performance. Interrater reliability, calculated using Fleiss' Kappa, was found to be 0.5 across 11 initial codes and 0.51 for our two final themes. Provider perspective varied with regards to barriers to care. Despite these differences, the trends seen for infrastructure reflect the importance of sustained investment in Nigerian health infrastructure. The high level of endorsement seen for the non-indication barrier may signal need for better ECAT adaptation for local practice & education, and for improved Nigerian emergency medical education and training. A low endorsement was seen for patient-facing costs, despite the high burden of Nigerian private expenditure on healthcare, indicating limited representation of patient-facing barriers. Analysis of open-ended responses was limited by the brevity and ambiguity of these responses on the ECAT. Further investigation is needed towards better representation of patient-facing barriers and qualitative approaches to evaluating Nigerian emergency care provision.

Impact of Workplace-Based Fitness on Development of an Individualized Physical Activity Program Among Nigerian Health Workers

Background: Workplace-based fitness program has been introduced as a means of motivating employees towards participating in active living, maintenance of healthy lifestyle behaviors and increase brain power and productivity. However, the effects of such program on development of individualized fitness program have not been evaluated. Objective: The focus of this study was to investigate the impact of workplace-based fitness on development of an individualized physical activity program among health workers. Method: The cross-sectional study recruited 177 clinical and administrative workers in a tertiary health institution. Data on demographic characteristics, health-benefit of exercise, physical activity level and development of an individualized physical activity program were obtained using a self-administered questionnaire. Data were summarized using a descriptive statistic of percentage and frequency distribution. Results: 172 (97.1%) of the participants are aware of the health benefits of physical activity and the monthly physical fitness program held in the hospital. Only 71 (40.1%) of those that are aware actually participated in the fitness program. 52 (73.2%) of those that participated in the monthly program have developed a personalized fitness program as a result of the motivation received through the monthly fitness program. Conclusions: Hospital workers are aware of the health-related benefits of physical activity however higher level of awareness does not always translate to high level of participation in physical activity. A well-designed workplace-based physical activity can help staff in developing an individualised fitness program. Employers of labour should incorporate workplace-based physical activity into their organisation as a means of promoting the health and fitness of their employee thereby improving productivity and reducing health cost of preventive diseases.

Review of Emerging and Re-Emerging Zoonotic Pathogens of Dogs in Nigeria: Missing Link in One Health Approach

Dogs live in close contact with humans as pets, for hunting, for security, and as a source of income. In addition, the meat is also consumed by some tribes in Nigeria. Dogs could therefore serve as reservoirs, carriers, and transmitters of zoonotic diseases. This review evaluates the literature from 2000 to 2020 for the prevalence and incidence of zoonotic pathogens associated with dogs in Nigeria. The results obtained show that overall, parasites constituted a majority (64%) of the zoonotic pathogens (or species) identified in dog hosts. A good number of studies have examined the role of ticks in the transmission of tick-borne pathogens. Further, bacteria make up 22% of the zoonotic pathogens. From this study, it appears that rabies is the major pathogen in dogs for which there is reliable evidence linking contact between humans and dogs. Oyo State in southwestern Nigeria and Plateau State in north-central Nigeria were the most frequently studied states, while prevalence/disease surveillance studies constituted 80% of the overall papers assessed. Interdisciplinary collaborations as well as research and diagnosis policy amendments are missing links to fully appreciate the role of dogs in the transmission of zoonotic diseases in Nigeria. Policies should integrate a one health approach in the Nigerian health system, whereby diagnostic screening of humans and animals by physicians and veterinarians includes zoonotic pathogens for more accurate diagnosis and control.

Improving the quality of life of people living with HIV/AIDS: A cross-sectional study of the role of religion.

Previous studies have found religion as a useful tool in coping with chronic medical conditions including HIV/AIDS. Aim: This study assessed how religiosity and religious coping are associated with quality of life (QOL) among people living with HIV/AIDS (PLWHA). This was a cross-sectional study of 140 HIV clinic attendees of a Nigerian tertiary health facility. Religiosity, religious coping and QOL were measured with religious orientation scale-revised (ROS-R), Brief Religious Coping (Brief RCOPE) and World Health Organization Quality of Life-Bref (WHOQOL-BREF), respectively. Correlation analysis assessed the relationship between ROS-R, Brief RCOPE and WHOQOL-BREF. : Intrinsic religiosity (IR) scores had a moderate positive correlation with psychological health domain of QOL (r = 0.4, N = 140, and P 0.001), and a weak positive correlation with physical health domain of QOL (r = 0.2, N = 140, and P 0.05). Extrinsic religiosity (ER) scores moderately correlated positively with the psychological health domain of QOL (r = 0.03, N = 140, and P 0.002), but weakly correlated positively with the physical health domain (r = 0.2, N = 140, and P 0.02). Positive religious coping (PRC) scores moderately correlated positively with the psychological health domain (r = 0.03, N = 140, and P 0.05) and weakly correlated positively with physical health domain of QOL (r = 0.2, N = 140, and P 0.02). Extrinsic religiosity social (ERS) scores had a moderate positive correlation with the social relationships domain (r = 0.4, N = 140, P 0.001). Increased ER, IR orientations and Positive Religious Coping appear to improve the psychological and physical health domains ofQOL QOL Therefore, religiosity should be encouraged among PLWHA to improve QOL.

Mediating Role of Job Satisfaction on the Relationship between Leadership Styles and Organizational Citizenship Behaviour in Nigerian Health Sector: Conceptual Model

Mediating Role of Job Satisfaction on the Relationship between Leadership Styles and Organizational Citizenship Behaviour in Nigerian Health Sector: Conceptual Model

Feasibility of preconception care services in the Nigerian health system - an exploration of stakeholders' viewpoints

Feasibility of preconception care services in the Nigerian health system - an exploration of stakeholders' viewpoints

Self Esteem, Depression and Life Satisfaction among HIV out Patients Receiving Highly Active Anti Retroviral Therapy in a Nigerian Teaching Hospital

Aim: The aim of this study is to investigate self esteem, depression and life satisfaction in a sample of HIV patients receiving highly active anti retroviral therapy (HAART) attending a Nigerian tertiary health institution.&#x0D; Study Design: The descriptive cross sectional study design was used for the study.&#x0D; Place and Duration of the Study: The study was carried out at the HIV/AIDS clinic of the university of Nigeria teaching hospital Enugu in south east Nigeria between the months of January and February 2023.&#x0D; Methodology: A total of 480 HIV/AIDS positive patients on HAART aged between 23 to 61 years attending the HIV/AIDS clinic of the University of Nigeria Teaching hospital Enugu who consented to participate in the study were assessed for self esteem, life satisfaction and depression with the Rosenberg self esteem scale, the life satisfaction scale by Diener and the Beck’s depression inventory version two.&#x0D; Results: Results revealed that 53.7% of the HIV patients on HAART manifested no signs of depression; 63.8% had high self esteem and 73.1% were satisfied with their lives; however 25.2%; 15.8% and 5.5% showed signs of mild, moderate and severe depression respectively; 36.2% had low self esteem, whereas 26.9% indicated not being satisfied with their lives.&#x0D; Conclusion: Following the benefits of HAARTS on the management of HIV/AIDS patients as noticed in the study, there is need for health workers to ensure strict adherence on HAART regimen for optimum suppression of HIV as recommended by The World Health Organization; furthermore, there is need to ensure continuous provision of psychological support to all HIV/AIDS patients as a way of reducing the psychosocial sequelae associated with HIV/AIDS.

Exploring the impact of COVID-19 on frontline health workers through a photovoice study in Kaduna, Kwara and Ogun States, Nigeria.

Described as the 'backbone of health systems', particularly in low- and middle-income countries, community health workers (CHWs) are a critical cadre on the frontline of any outbreak response. However, it is widely recognised that CHWs are frequently lacking in appropriate support from the health system due to inadequate physical, social and financial resources. Furthermore, despite their critical role in service delivery, the health and well-being of CHWs is seldom considered and the additional emotional and physical burdens that health systems shocks can present are frequently ignored. Thus a critical step in strengthening health systems to manage disease outbreaks or other system shocks is to ensure that CHWs are adequately supported. Within this study we document the experiences of CHWs within Nigeria during the coronavirus disease 2019 (COVID-19) outbreak to understand the impact of the pandemic on CHW well-being with a view to identifying strategies that could support CHWs during COVID-19 and subsequent health system shocks. This study was based in Ogun, Kaduna and Kwara States, Nigeria. We used the creative participatory methodology of photovoice with 30 CHWs (10 in each state). Participants were asked to take photos documenting their experiences of working and living through the pandemic. Participants sent photos with captions to the research team via WhatsApp following one-on-one discussions. Photos were co-analysed among participants in focus group discussions using thematic analysis. Our findings reveal similar experiences of CHWs across Ogun, Kwara and Kaduna States in Nigeria, providing a unique insight into how the Nigerian health system was impacted and how this closely aligns to the performance and well-being of CHWs. CHW experiences related to three overarching themes: major stressors and challenges experienced due to COVID-19 (fear of contracting COVID-19, food insecurity, personal and gendered impacts), the impact of COVID-19 on providing routine care (stigma from community members, heavy workloads and inadequate equipment provision) and motivation and support from the community (pride in their roles and valued support from community leaders). The challenges highlighted through photovoice led to developing recommendations to address some of the challenges. This included training, adequate resource provision, routine supervision and peer support. COVID-19 highlighted the burden health workers often face. Photovoice allowed a space for frontline health workers to come together to share common experiences, particularly the psychosocial impact of working during health system shocks and its impact on performance. This underlines the need to acknowledge mental health and prioritise the well-being of healthcare staff. Sharing stories from the perspectives of health workers provides a platform to share learning and strategies on how to best support health workers holistically, particularly during health system shocks.

Advancing the Nigerian health system through advanced practice nursing

Background &amp; Aim: To meet the changing global population needs and demands of patient care, healthcare systems worldwide are under restructuring and transformation. Advanced practice nursing has been adopted in many developed countries to meet pressing issues like workforce shortage and equitable distribution of competent healthcare professionals. However, Nigeria is yet to take advantage of this initiative despite being seriously affected by these issues. This article documents the need for and prospects of advanced practice nursing in Nigeria.&#x0D; Methods &amp; Materials: A descriptive theoretical and empirical literature analysis was done to explain the impact of advanced practice nursing in advancing the Nigerian health system.&#x0D; Results: The expertise and capacity of the nursing workforce, especially its numerical strength, can be utilized to improve Nigeria’s health system and achieve the global goal of making quality healthcare accessible and available to all, thereby achieving universal health coverage.&#x0D; Conclusion: Elevating the competencies of nurses through investments in advanced practice nursing will make primary healthcare available to Nigerians living in poverty, rural dwellers, youth, and children, thereby reducing the burden of diseases and improving health promotion and disease prevention.

CAUTI‐bundle application in patients' care among nurses in a Nigerian tertiary health facility

AbstractCatheter associated urinary tract infection (CAUTI) is the most prevalent healthcare‐associated infection worldwide, and the use of care bundles such as CAUTI bundles has been identified as the most effective ways of preventing it. This cross sectional descriptive study thus, evaluated the application and barriers to application of CAUTI bundles in patients' care among nurses in a tertiary government hospitals. Census method was used to recruit into the study all 446 registered nurses and midwives who met the inclusion criteria in the institution; thus, no sampling was done to select the participants from the study area. Data were collected by means of researchers' developed and validated semi‐structured self‐administered questionnaire delivered through Google drive. Univariate and bivariate data analyses were conducted with the aid of SPSS version 24. Results of the study revealed that only 7 (1.9%) of the nurses claimed they always use written guidelines during catheter insertion, whilst majority 57.4% do not follow any written protocol or guidelines when inserting catheter. The use of aseptic non‐touch technique was always done by 80% of the respondents. In general, score on compliance with the bundles was poor, as only 46.4% of the respondents correctly apply the bundles to patients' care. Barriers to application of the bundles as revealed by the results include; lack of written policy/guideline documents on CAUTI bundles in the facility (100%), lack of existing monitoring and feedback tools (98.9%), Supervisors/staff do not feel empowered to challenge suboptimal practices in a safe way (52.4%), lack of team meeting/ward round routinely addressing patients with indwelling urinary catheter (78.6%). It is thus, imperative to conclude that although the nurses in this study have some knowledge about the catheter associated urinary tract infections' bundles, their application of the bundles to patients' care is very poor, and was found to be due to some modifiable barriers. These barriers are some of the areas nurse educators and hospital policy‐makers should focus in their bid to curbing healthcare acquired infections.

Designing feasible anti-corruption strategies in the Nigerian health system: A latent class analysis of a discrete choice experiment

Health worker absenteeism is a major form of corruption in the Nigerian health system, reducing the impact of healthcare investment and disproportionately affecting vulnerable communities. Top-down governance and accountability measures to improve attendance have had limited effect, potentially because they have not addressed underlying incentives driving health worker behaviour. To inform feasible interventions to reduce absenteeism, we sought to investigate how potential interventions targeting key drivers of absenteeism could influence behaviour through a discrete choice experiment with 412 primary health care workers in Enugu State, Nigeria. The experiment included six attributes drawing on a literature review, qualitative research and stakeholder consultation: facility relationship with the community, method of supervision, attendance-related rewards or punishments, flexible working policy, posting location and financial incentives. Respondent choices were analysed with mixed multinomial logistic and latent class models and used to simulate job uptake under different policies. We found all attributes significantly influenced choices: workers strongly preferred jobs that facilitated supportive community relationships (β = 0.37), had a financial incentive worth 10 % of a worker’s salary (β = 0.39), rewarded attendance with credit towards promotion (β = 0.25) or placement in training (β = 0.14), and offered flexible work conditions (β = 0.14). Using latent class analysis, we identified two sub-groups of workers who differed in their willingness to accept a job and preferences over specific attributes, suggesting some may be more susceptible to feasible interventions to improve attendance. We argue that focusing on the needs of these groups may offer a path to incrementally, but sustainably, reduce absenteeism across the system. Our findings build on frameworks developed in anti-corruption research in other sectors only recently been applied to the health sector. The work represents some of the only empirical evidence to inform anti-corruption strategies in Nigeria and internationally, with findings relevant to other low- and middle-income countries seeking to combat absenteeism among primary health care workers.

An empirical comparison of the performances of single structure columnar in-memory and disk-resident data storage techniques using healthcare big data

Healthcare data in images, texts and other unstructured formats have continued to grow exponentially while generating storage concerns. Even though there are other complexities, volume complexity is a major challenge for Disk-Resident technique in storage optimization. Hence, this research aimed to empirically compare the efficiency of Disk-Resident and In-Memory single structure database technique (as opposed to multiple structure In-Memory database), using descriptive and inferential big data analytical approaches. The essence was to discover a more cost-effective storage option for healthcare big data. Data from Nigerian Health Insurance Scheme (NHIS) alongside sample patients’ history from Made-in-Nigeria Primary Healthcare Information System (MINPHIS) which included patients’ investigation, patients’ bio-data and patients’ diagnoses were the primary data for this research. An implementation of both Disk-Resident and single structure In-Memory resident data storage was carried out on these big data sources. After storage, each quantity of data items stored for different data items in Disk-Resident was then compared with that of single structure In-Memory resident system using size of items as comparison criteria and different analyses made.The results obtained showed that single structure In-Memory technique conserved up to 90.57% of memory spaces with respect to the traditional (common) Disk-Resident technique for text data items. This shows that with this In-Memory technique, an improved performance in terms of storage was obtained.

Can Public Health Expenditure Influence National Productivity in an Agrarian Economy? Evidence from Nigeria

Despite the nation’s wealth in natural and human resources, productivity measure in Nigeria has not been satisfactory. Several factors have been alluded to be responsible for this. This paper investigated the impact of public health expenditure (with gross capital formation and secondary school enrolment as control variables) on national productivity (real GDP divided by working population as proxy) in Nigeria between 2000 and 2020. The theoretical foundation was based on Solow Neo-classical and Romer Endogenous growth models. The unit root test showed that variables were stationary at level. The descriptive result shows significant fluctuations in government domestic expenditure on health with an average of 18% of total health expenditure. Regression results showed a significant and positive relationship between healthcare service expenditures and productivity in Nigeria. The study recommended that Nigerian health policies should focus on developing the domestic health sector by increasing yearly budgetary allocation to the sector.

Mistrust of the Nigerian health system and its practical implications: Qualitative insights from professionals and non-professionals in the Nigerian health system

Mistrust of the Nigerian health system and its practical implications: Qualitative insights from professionals and non-professionals in the Nigerian health system

Outcomes of Evacuating Subacute Extradural Hematoma Through a Minicraniectomy: A 5-Year Study

Abstract Background Extradural hematoma (EDH) is a hematoma between the dura and the inner surface of the skull, found in 1 to 3% of all head-injured patients, rising to 9% among the unconscious ones. It is said to be subacute when about 2 to 4 days old. Further enlargement of the burr hole to about 3 to 5 cm wide (minicraniectomy) may allow its total evacuation. Objective To recommend it as a treatment option, this study aims to evaluate the surgical outcomes of evacuating a subacute EDH through a minicraniectomy. Method This was a 5-year prospective study in a Nigerian tertiary health institution. Results In total, 108 patients, consisting of 96 males and 12 females with a male to female ratio of 8:1 were included. Their ages ranged from 10 to 69 years. Etiologies were road traffic accident (RTA, 73.2%), assault (18.5%), and falls (8.3%). Hematoma ages were 2 days (61.1%), 3 days (25%), 4 days (13.9%). GCS were mild (11%), moderate (56%), and severe (33%). Locations were right-sided (59.3%), left-sided (40.7%) with 73.1% in parietotemporal area. Active bleeding was encountered in 15% only. Postoperative complications were seizure (13.9%), death (12%), and surgical site infection (4.6%) among others. Outcomes at 2 weeks were good (83, 76.9%), moderate disability (12, 11.1%), severe disability (10, 9.3%), vegetative (1, 0.9%), and death (2, 1.9%). Conclusion Considering the significant morbidity and mortality and the need for urgent interventions in EDH, most patients presenting in the subacute acute (2–4 days) stage can be evacuated via a minicraniectomy with good outcomes.