Tertiary Health Institution Research Articles

Management of melanoma of the foot in our subregion: Is preliminary biopsy always required?

Background: Majority of patients with melanoma of the foot in our subregion present late. After preliminary excision biopsy for these patients, many of them do not come back for further excision when there is an indication to do so following biopsy result. A better result could be achieved by using wider margins for excision biopsy in patients with low socio-economic status. Objectives: We assessed the role of excision of melanoma of the foot without preliminary biopsy as an option in the management of melanoma of the foot in our subregion. Materials and Methods: This was a 5-year retrospective review of patients with melanoma of the foot that presented to a tertiary health institution in Nigeria from December 1, 2014 to November 30, 2019. Results: Half of the patients with lesions that have not advanced locally (35.3%) had wide local excision with 2–3 cm margin without preliminary biopsy, relying on clinical diagnosis of melanoma. Another 35.3% of same number as those mentioned above were managed by doing a preliminary biopsy. Incision biopsy was employed for those with distant metastasis or lesions where amputation of any form was indicated (29.4%). Conclusion: Melanoma of the foot can be diagnosed clinically with a high degree of accuracy in majority of patients. Preliminary biopsy is essential for lesions requiring amputation or very large lesions. For small lesions, excision biopsy with wider margins than is used for preliminary biopsy is beneficial especially for poor patients who tend to delay having a second surgery that is definitive due to financial constraint, ignorance, or other reasons.

Assessment of Serum Copper and Zinc Status in Patients Receiving Highly Active Antiretroviral Therapy in A Tertiary Health Institution in Southwest Nigeria

The poor prognosis and mortality in HIV infection has been associated with deficiency of micronutrients such as zinc and copper. This study aimed to investigate the level and deficiency of some trace elements in HIV-seropositive subjects receiving HAART treatment.

EVALUATION OF FAMILY MEDICINE PRACTICE FROM THE INDIVIDUAL PERSPECTIVE: A RESEARCH IN BITLIS

Amaç: Bu çalışma, Bitlis ilinde yaşayan bireylerin aile hekimleri ve aile hekimliği uygulaması hakkındaki değerlendirmelerini ortaya çıkarmak ve demografik bilgiler bakımından farklılıkları tespit etmek amacıyla gerçekleştirildi.
 Yöntem: Araştırmanın amacına uygun şekilde oluşturulan model ve hipotezler nicel yöntemlerle analiz edildi. Araştırma verileri 433 kişiyle yüz yüze görüşerek soru formu aracılığı ile elde edildi. Verilerin normal dağılımı nedeniyle parametrik testler kullanılarak analizler yapıldı. Kesitsel bir araştırma yapılmış olup Mart-Nisan 2019 tarihleri arasında veri toplandı. Betimsel istatistikler ve farklılıkların tespitine yönelik Anova ve bağımsız örneklem t testleri yapıldı.
 Bulgular: Katılımcıların aile hekimlerine yönelik tutumları incelendiğinde; çoğunluğunun aile hekimlerini tanıdıkları ve aile hekimlerinin kendilerine olan yaklaşımlarını olumlu değerlendirdiği fakat aile hekimliğine gitme sıklığının genel olarak düşük olduğu tespit edildi. Aile hekimini değiştirmemeleri veya değiştirme niyetlerinin olmamasına rağmen bu hekimler dışındaki hekimleri tercih ettikleri belirlendi. Ayrıca katılımcıların büyük bir çoğunluğunun aile sağlığı merkezlerinin kendilerine yakın konumda olması nedeniyle aile hekimlerini tercih ettikleri saptandı. Elde edilen bulgulara göre yaşı küçük, lise mezunu ve çocuğu olmayan katılımcıların tutum düzeylerinin diğerlerine göre istatistiksel olarak anlamlı düzeyde daha düşük olduğu; evli olanların, aile hekimini tavsiye edenlerin ve geliri diğerlerine göre daha yüksek olanların tutum düzeylerinin ise daha yüksek olduğu sonucuna ulaşıldı. 
 Sonuç: Herhangi bir rahatsızlık durumunda ilk olarak aile hekimine gitme oranlarının yükseltilebilmesi, sağlıklı bir sevk zincirinin oluşturulabilmesi için ilk olarak aile hekimine gidilmeme nedenlerinin araştırılması gerekmektedir. Böylelikle sağlık sisteminin etkin çalışması ve ikinci ve üçüncü basamak sağlık kuruluşlarının yükünün azaltılması mümkün olacaktır.

Haematological And Inflammatory Markers Among Paediatrics With Sickle Cell Anaemia Attending Tertiary Health Institutions in Ekiti State, Nigeria.

Sickle cell anaemia is one of the life threatening health challenges bedevilling many developing countries like Nigeria and the management requires regular monitoring of the patients. The aim of this study was to determine haematological parameters and inflammatory markers among paediatrics with sickle cell anaemia. A total of 90 subjects were recruited for this study comprising of 45 confirmed sickle cell anaemia patients in steady state, 32 males and 13 females and 45 apparently healthy subjects with haemoglobin genotypes AA were used as the controls. Automated blood analyzer was used to analyze haematological parameters, erythrocyte sedimentation rate was estimated by Westergreen method and C-reactive protein was estimated using Enzyme Linked Immuno-Sorbent method. Total white blood cell count, white cell differential count, mean cell volume, mean cell haemoglobin, mean cell haemoglobin concentration, red cell distribution width, platelet count, platelet distribution width, erythrocyte sedimentation rate, C-reactive protein was higher in case compared to control. However, red blood cell count, haemoglobin, haematocrit, plateletcrit and mean platelet volume were lower in the case compared to the control subjects. There is no significant (p>0.05) difference in haematological parameters, erythrocyte sedimentation rate and C-reactive protein among the gender in both the case and the control except plateletcrit in the case and eosinophil and red cell distribution width in the control. There is similarity in haematocrit in both sex among the case. It is our anticipation that these findings will greatly assist physicians in the better management of Sickle cell patients in our locality.

Workplace Commitment Among Nurses in Edo State Nigeria: A Cross-Sectional Study

Aim: To assess the level of workplace commitment among Nurses in Edo state tertiary health institutions. Design: A cross-sectional study. Method: An adapted self-administered questionnaire was utilised for data collection, 326 nurses were administered a questionnaire between October 4th to November 12th, 2021 to assess workplace commitment among nurses working in Edo state and to identify the relationship between the categorical variable (gender, age and length of service). Statistical Package for Social Science (SPSS) version 25 and the Chi-Square test were used for the analysis. The result was presented in tables. Result: Ninety-five per cent (310) of the participants filled and returned their questionnaire, among the respondent was 66.8% female. Regarding the workplace commitment sub-construct, the affective and continuance saw 44.13% and 42.64% disagreement respectively while 42.57% agreed on normative. The participants, (41.81%) expressed low levels of workplace commitment and there was no significant relationship between the categorical variables and workplace commitment. Conclusion: The low level of workplace commitment among nurses is not a good phenomenon for health institutions as this may reduce nurses' output and necessitate intent to leave for another health care facility either within or outside the shores of Nigeria adding to the stress of the remaining healthcare worker. Therefore, it is expedient to improve nurses' rewards accordingly, ensure a good leadership style, and involve them in policy-making in the hospital to improve their attachment and identification with their place of work.

Histopathological Characteristics of Breast Lesions in a Tertiary Health Institution in Southwest Nigeria; A 9-year Review

Background: The breast is affected by several diseases, including developmental, inflammatory, and neoplastic. While benign breast neoplasms are usually more common, breast cancer is the most common nonskin cancer and the leading cause of cancer-related deaths in women after lung cancer in the world. Objective: The review aimed to assess the histopathological diagnosis of breast lesions over a period of 9years Methods: This was a retrospective review of eight hundred and fourteen histopathologic cases of breast lesions accessed through laboratory records of all breast lesions cases seen. The demographic data were obtained and the patient’s histology slides were reviewed. The tumors were classified according to the WHO International Classification of breast tumors and Malignant breast tumors were graded according to the Nottingham grading system. Data were analyzed using SPSS version 25. Results: The majority of breast cancer cases were seen in patients below 40 years, malignant cases were predominant in older age groups (40 – 59 years; 57.4%, 60 years and above; 23.3%) and malignancy was significantly associated with age group, p-value < 0.05. The prevailing neoplasm was Benign type (68.3%) while malignant neoplasm accounted for 30.2% and invasive ductal carcinoma (89.1%) was most prevalent. Moreso, the majority were in grade 2; 152 (76.8%) using the Nottigham grading system. However, the commonest benign neoplasm was fibroadenoma (53.7%) followed by fibrocystic change (20.1%). Conclusion: Breast lesions are common in this environment. Benign breast neoplasms are commoner than malignant diseases. One in three of every sub-Saharan woman diagnosed with malignant breast lesion may not survive five years post-diagnosis. The prognosis of breast malignancies in sub-Saharan is poor due to late Presentation, ignorance and poverty.

KNOWLEDGE AND ATTITUDE OF HEALTH PROFESSIONALS ON PALLIATIVE CARE OF TERMINALLY-ILL PATIENTS IN A TERTIARY HEALTH INSTITUTION OF SOUTHWESTERN NIGERIA: A CROSS SECTIONAL STUDY

Existing information on Palliative Care (PC) indicated an increase in development of services in some African countries with Nigeria in top three on specialized care. However, knowledge and skill deficit in PC among health professionals (HP) is a significant barrier to quality treatment of patients with chronic life-threatening diseases. The aim of this study was to investigate the knowledge and attitude of PC among HP in a tertiary health institution in Nigeria. This cross-sectional study involved 260 consenting HP (Medical doctors, Nurses, Occupational therapists, Physiotherapists, and Social workers), purposively recruited from Obafemi Awolowo University Teaching Hospital, Ile-Ife. Attitude and knowledge were assessed using Frommelt attitude towards care of the dying (FATCOD) and the Palliative care attitude and knowledge quiz (PCAK) questionnaires respectively. Also, socio-demographic information of the respondents was obtained. Descriptive statistics of mean, standard deviation, frequency and percentages; and inferential statistics of Chi-Square test and Pearson’s correlation were used to analyze data. Alpha level was set at p<0.05. Majority (80%) of the respondents had never received formal PC training and demonstrated poor PC knowledge. Only 13 (5%) had good knowledge of, while 257 (98%) had favourable attitude towards PC. There were significant associations between respondents’ socio-demographic characteristics and each of knowledge of PC (p<0.05) and attitude towards PC (p= 0.001). Results of Pearson’s correlation indicated significant correlation between knowledge and attitude of the respondents on PC (r= 0.167, p=0.007). Most of the HP in this study had poor knowledge but favourable attitude towards PC. PC should be included in the undergraduate curriculum of concerned HP and continuous professional training be integrated for practicing professionals

Assessment of nurses' perception of role of genetics in development of breast cancer at Federal Teaching Hospital, Ido-Ekiti

ObjectiveChanges in the traditional approaches to prevention, diagnosis, and therapeutic management of breast cancer are becoming increasingly genetically based. It is therefore important for nurses to have competency in underlying biology of carcinogenesis and the molecular rationale underlying strategies to prevent, diagnose, and treat breast cancer. The risk for breast cancer is increased in individuals carrying a mutation in a predisposing gene and in others with a number of affected relatives with early age of disease onset. The authors investigated perception of nurses on the role of genetics in the development of breast cancer. Methods and materialA descriptive quantitative research design was adopted as the research design. The instrument for data collection was an adapted, pre-tested semi-structured, and self-administered questionnaire. Study participants were 187 nurses working at a tertiary health institution in Ekiti State. Data were analyzed and summarized using both descriptive and inferential statistics with level of significance set at P < .05. ResultsThe mean age of respondents was 39 ± 9.1 years and majority (86.2%) were females and B.Sc. (Bachelor of Science) (53.2%), with more than a decade working experience (62.2%). The study revealed that knowledge of the role of genetics in development of breast cancer was low among respondents with only a few (25.6%) having good knowledge. Although majority of the respondents had good perception of genetic counseling, only 40% had good practice of genetic assessment and counseling with a few of them ever using “Family pedigree trees”, “ever referred a breast cancer patient for genetic assessment”, and with many reporting “difficulties guiding breast cancer patients in seeking genetic counselling”… ConclusionDespite high level of education, knowledge, and practice of genetic counseling and assessment is poor among the respondents, with many reporting difficulties guiding breast cancer patients/relatives in seeking genetic counseling.

Histopathological Characteristics of Breast Lesions in a Tertiary Health Institution in Southwest Nigeria: A 9-year Review

Background: The breast is affected by several diseases, including developmental, inflammatory, and neoplastic. While benign breast neoplasms are usually more common, breast cancer is the most common nonskin cancer and the leading cause of cancer-related deaths in women after lung cancer in the world.&#x0D; Objective: The review aimed to assess the histopathological diagnosis of breast lesions over a period of 9years&#x0D; Methods: This was a retrospective review of eight hundred and fourteen histopathologic cases of breast lesions accessed through laboratory records of all breast lesions cases seen. The demographic data were obtained and the patient’s histology slides were reviewed. The tumors were classified according to the WHO International Classification of breast tumors and Malignant breast tumors were graded according to the Nottingham grading system. Data were analyzed using SPSS version 25.&#x0D; Results: The majority of breast cancer cases were seen in patients below 40 years, malignant cases were predominant in older age groups (40 – 59 years; 57.4%, 60 years and above; 23.3%) and malignancy was significantly associated with age group, p-value &lt; 0.05. The prevailing neoplasm was Benign type (68.3%) while malignant neoplasm accounted for 30.2% and invasive ductal carcinoma (89.1%) was most prevalent. Moreso, the majority were in grade 2; 152 (76.8%) using the Nottigham grading system. However, the commonest benign neoplasm was fibroadenoma (53.7%) followed by fibrocystic change (20.1%).&#x0D; Conclusion: Breast lesions are common in this environment. Benign breast neoplasms are more commoner than malignant diseases. One in three of every sub-Saharan woman diagnosed with malignant breast lesion may not survive five years post-diagnosis. The prognosis of breast malignancies in sub-Saharan is poor due to late Presentation, ignorance, and poverty.

A Historical Review of Liberia’s Public Health Evolution—Past, Present &amp; Future

Over the past two centuries since its independence in 1847, Liberia has made significant progress in building an integrated public health system designed to serve its population. Despite a prolonged period of civil conflict (1990–2003) and the emergence of the 2014–2016 Ebola Virus Disease (EVD) that crippled its already weakened health system, Liberia was able to re-emerge, making significant strides and gains in rebuilding and strengthening its health infrastructure and systems. Lessons learnt from the EVD epidemic have led to developments such as the newly established National Public Health Institute of Liberia (NPHIL) and several tertiary public health institutions to meet the growing demands of a skilled workforce equipped to combat existing and emerging health problems and/crisis, including informing the more recent COVID-19 response. This article delineated and documented the historical efforts made towards establishing public health interventions such as infrastructures and systems of the past, and how these structures and systems became the foundation and pillars of the current resilient health system. This paper highlighted some of the key crises and interventions deployed, and some of the historical public health champions, laws, and policies that aided in strengthening the public health systems then and now. It is expected that in addition this paper can be used as a guide for further or future research.

Willingness to Accept COVID-19 Vaccine among Anaesthetists in Nigeria

Background: Critical measures in the prevention and control of COVID-19 disease require health care professionals. This study aimed to assess the willingness to accept COVID-19 vaccine among anaesthetists in Nigeria.&#x0D; Methods: A descriptive cross-sectional study involving the total population of anaesthetists in Nigeria was carried out with the use of self-administered questionnaires. Data were analyzed using IBM SPSS version 21.0 statistical software.&#x0D; Results: A total of 195 respondents were assessed during this study. All of them were aware of COVID-19 disease, 119 (61%) had a good knowledge of COVID-19 disease while 57 (29.2%) and 19 (9.7%) had fair and poor knowledge, respectively. Over half of the respondents, 103 (52.8%) were willing to accept the vaccine. Predictors of willingness to accept the vaccine included being of the male gender (AOR=2.5, 95%CI=1.213-5.246, p=0.013), being from the South-west geopolitical zone (AOR=3.134, 95% CI= 1.353- 8.651, p=0.020) and having a good knowledge of the vaccine (AOR=14.910, 95%CI=6.114-36.359, p= &lt;0.001).&#x0D; Conclusion: Slightly over half of the respondents were willing to accept COVID 19 vaccines. There is an urgent need for tertiary health institutions in Nigeria to sensitize anaesthetists especially the females on the need to accept the vaccine.

Eagle’s syndrome in tertiary health institution, southern region of Nigeria

Eagle’s syndrome is a condition caused by elongation of the styloid process or ossification of the styloid ligament resulting in non-specific symptoms related to pressure on vital blood vessels of the neck, the internal carotid artery, internal jugular vein, and nerves; the glossopharyngeal and vagus nerves. Eagle’s syndrome may have varied presentations with numerous symptoms: Pain in the throat/neck radiating to the ear and pharynx, foreign body sensation in the throat, dysphagia, otalgia, trismus, and intense facial pain. A high index of suspicion with a prompt resort to a three-dimensional CT skull could be helpful to give a quick diagnosis of Eagle’s syndrome amid numerous differential diagnoses. We present a 59-year-old male with an 18-month history of left-sided neck pain, cheek pain, and the feeling of a foreign body in the throat. He had pain relievers and other drugs to no avail. A three-dimensional CT scan of his skull revealed features of Eagle’s syndrome. The excision of the styloid process through the extraoral route relieves his symptoms. The second patient is a 42-year-old female with symptoms of peptic ulcer disease, dysphagia, pain in the throat, and sometimes fainting attacks when she moves her neck swiftly to the left side. A three-dimensional CT skull scan confirmed features of an elongated styloid process bilaterally suggestive of Eagle’s syndrome. Treatment offered to her was conservative, with a diclofenac suppository only because she refused surgery. Restricted and limited neck movement relieved her of syncope attacks.

The Distribution Pattern of Acinetobacter baumannii Isolated from Two Tertiary Health Institutions in Rivers State, Nigeria

The ubiquitous nature of Acinetobacter baumannii has made the Gram-negative, non-motile bacterium to be associated with hospital-acquired infection at the global level, and with respect to antimicrobial resistance, it has been categorized among the most dangerous multiple drug-resistant (MDR) pathogens globally and enlisted in the "priority 1: critical" pathogens list of the World Health Organization, existing in-hospital patients and environment. Many clinical manifestations such as pneumonia, and wound infection have posed a huge disease burden with massive economic loss. The infection is associated with high morbidity and mortality rates. The burden of this hospital pathogen demands attention, especially with the surge in the resistant strains distribution. In the area of this study, distribution patterns have not extensively been studied therefore, the research focused on the distribution pattern of hospital isolated Acinetobacter baumannii from selected tertiary health facilities in Rivers State Nigeria. The observational study involved isolation and biochemical identification, as well as molecular assay, which was performed using standardized methods, was conducted in two main tertiary hospitals located in Port Harcourt metropolis, Rivers State, Nigeria. Statistics were performed for percentage and frequency distribution. Kruskal-Wallis and Mann-Whitney tests were used to compare the difference in distribution at a 0.05 level of significance. Statistical Package for Social Science version 21 was used for the statistics.368 samples from two institutions; RSUTH 185 (50.3%) and UPTH 183 (49.7%). Females 187 (50.8%) were more compared to the males 181(49.2%) with a significant difference (p&lt;0.05) in isolate distribution but no statistically significant difference (p&gt;0.05) for location and sample. Also, sample distribution was uneven 59 (16.0%), 202 (54.9%), and 107 (29.1%) for aspirate, urine, and wound respectively. 2.4% was recorded in the preliminary investigation while a 75% positive rate was observed using the molecular method. Evidence of the presence of Acinetobacter baumannii in the hospital was established. Also, Acinetobacter baumanii was not isolated from the aspirate sample however, this is subject to further investigation with an increased sample size. Female subjects had a higher rate. The information obtained here is essential to guide therapeutics and the management of targeted clinical manifestation. Therefore, the study serves as surveillance of A. baumannii found in the selected region.

Assessing the level of knowledge, uptake of hepatitis B virus vaccine, and its determinants among health workers across various levels of health facilities in Ondo, South West, Nigeria

Problem consideredResearch has shown that health care personnel is at higher risk of acquiring the disease than the general population. In spite of this challenge, there has been a low vaccination record among the Health WorkersThe aim of this study was to investigate the relationship between knowledge, attitude, perception, and practice of hepatitis B vaccination among health workers in Akure South Local Government Area of Ondo State, NigeriaMethodsAn institution-based cross-sectional study was conducted with 260 health professionals working at primary health centers (40), private hospitals (60), and tertiary health institutions (160). Data was collected by using self-administered questionnaires distributed at the participant’s work unit and analyzed using SPSS version 20.ResultsThe result showed that there was a statistically significant relationship between the knowledge of Health workers about the HBV vaccine and vaccine uptake.While all the non-vaccinated health workers showed interest in taking the vaccine, the majority of them (80.4 %) suggested that the vaccine should be given free to health workers.ConclusionThe study revealed that the health workers had a good knowledge of hepatitis infection but not the vaccination which affected vaccine uptake as a significant relationship exists between the two. Also, the greatest hindrance to the uptake of the vaccine is the cost of the vaccine. HBV vaccination should be made compulsory as part of occupational protection measures and made readily available gratis for all health workers.

Pattern and awareness of complementary and alternative medicine usage for otorhinolaryngological problems among residents in Ekiti State.

The use of complementary and alternative medicine (CAM) in the treatment of various ailments globally has called for more research. This study aimed to draw the attention of the stakeholders to the prevalence, pattern and awareness of CAM usage in otorhinolaryngological ailments and the need to safeguard the health of CAM users in Ekiti state, south - west Nigeria. This is a cross sectional descriptive study carried out over a 12-month period (January to December, 2019) among consented patients that attended ear, nose, and Throat (ENT) clinics in two tertiary health institutions in Ekiti state. All the participants are aged 18 years and above. A self-administered semi structured questionnaire was used to collect data from our respondents. A total of 148 respondents were analyzed comprising of 56 (37.8%) males and 92 (62.2%) females given a male to female ratio of 1:1.6. Their age ranged from 20-79 years with a mean of 48.03 ± 15.11 SD. The highest response was in the age group 40-49 years representing 30.4% of the respondents. About half (51.4%) of our respondents were aware of the use of CAM for throat-related conditions. Few of the respondents (18.9%) are currently using CAM. About 33.1% of our respondents were satisfied with CAM. Only 4 (2.7%) of them experienced side effects to the use of CAM. For ear-related problems, Anointing/Olive (Olea europaea) oil was most commonly used in 34.5% of our respondents; Effinrin (Ocimum gratissimum), a local herb was commonly used in 29.7% for nose and local gin in 37.2% of our respondents for throat problems. Majority of them 44 (29.7%) got information about the various agents used through Vendors/traditional health practitioner. This study showed that the prevalent of CAM usage in ORL is quite low in our setting, which represent about one-fifth of the respondents. Although respondents claimed that the system was efficacious, awareness to its usage was very low and there was no evidence to prove that the diagnosis were known before using CAM. The use of Orthodox method in treating Otorhinolaryngological ailments is still the best. We therefore recommend empirical studies on CAM in future.

Evaluation of Haematological and Immune Status of Patients with Renal Dysfunction in Haematology and Blood Transfusion Department in a Tertiary Health Institution

Background: Renal dysfunction is a global public health issue where steadily progressive degradation of kidney function leads to multiple haematological and immune dysfunctions that, if adequate steps are not taken to monitor them, it renders patients vulnerable to cardiovascular morbidity and mortality. This study was aimed at evaluating the haematological and immune status of patients with renal dysfunction in blood and transfusion department of the National Hospital Abuja, Nigeria. Methods: Eighty-eight participants comprising 60 renal failure patients and 28 healthy control subjects were recruited into the study between January and August 2020. Haemoglobin parameters such as total white blood cell count (WBC), haemoglobin (Hb), packed cell volume (PCV) and platelet (PLT) counts were assessed for the subjects and controls. Similarly, CD4 and CD8 counts were also determined for subjects and controls. Results were analyzed using IBM SPSS Inc., Chicago, IL, USA version 25.0 for Windows. Results: PCV, Hb, and PLTs significantly reduced in subjects (24.0815.7%, 7.9711.76 g/dl, and 150.06184.18 x109/L) compared to the control (41.312.52%, 13.7610.74 g/dl, and 252.6159.34 x109/L) whereas WBC significantly increased in case (5.7912.99 x109/L) than control (5.1811.29 x109/L), P &lt; 0.05. The CD4 and CD8 count significantly decreased (P&lt;0.001) in patients with renal failure (180.22169.49 cells/µL and 145.76150.87 cells/pl) compared to control (925182.62 cells/µL and 809.8195.02 cells/pl) (P&lt;0.05). There was a significant difference (P&lt;0.001) between anaemia grades for patients with renal failure and control. Conclusions: Renal dysfunction is significantly associated with various degrees of irregularity in haematological parameters that need proper evaluation, monitoring and treatment.

Prevalence and pattern of migration intention of doctors undergoing training programmes in public tertiary hospitals in Ekiti State, Nigeria

BackgroundEmigration of Nigerian doctors, including those undergoing training, to the developed countries in Europe and Americas has reached an alarming rate.ObjectiveThis study aimed at assessing the prevalence, pattern, and determinants of migration intention among doctors undergoing residency and internship training programmes in the public tertiary hospitals in Ekiti state, Nigeria.MethodsThis was a cross-sectional study using a quantitative data collected from 182 doctors undergoing residency and internship training at the two tertiary hospitals. An adapted semi-structured questionnaire was used to collect information on migration intention among the eligible respondents. Univariate, bivariate and multivariate data analyses were done. The level of significance was determined at p-value < 0.05.ResultsMajority (53.9%) of doctors undergoing training were between 30–39 years, and the mean age was 33.2 ± 5.7 years, male respondents were 68.1%, and 53.8% of the respondents were married. The proportion of doctors undergoing training who had the intention to migrate abroad to practice was 74.2%. A higher proportion of the internship trainees, 79.5%, intended to migrate abroad to practice while the proportion among the resident doctors, was 70.6%. Among the respondents who intended to migrate abroad to practice, 85(63%) intend to migrate abroad within the next 2 years, while the preferred countries of destination were the United Kingdom 65(48.2%), Canada 29 (21.5%), Australia 20 (14.8%) and the United States 18(13.3%). Seventy percent of respondents who intend to migrate abroad had started working on implementation of their intention to migrate abroad. The majority of the junior resident doctors, 56(72.7%), intend to migrate abroad compared with the senior resident doctors, 21(27.3%), (χ2 = 14.039; p < 0.001). The determinants of migration intention are the stage of residency training and level of job satisfaction.ConclusionThere is a high prevalence of migration intention among the doctors undergoing training in the public tertiary hospitals in Ekiti State, Nigeria, with the majority already working on their plans to migrate abroad. Doctors undergoing training who are satisfied with their job and those who are in the senior stage of residency training programme are less inclined to migrate abroad.RecommendationsThe hospital management in the tertiary hospitals should develop retention strategies for human resources for health, especially doctors undergoing training in their establishment, to avert the possible problems of dearth of specialists in the tertiary health facilities. Also, necessary support should be provided for the residency training programme in the tertiary health institutions to make transition from junior to senior residency stage less strenuous.

Socio-Demographic Correlates of Antiretroviral Treatment Adherence among Paediatric HIV Patients Under Care at A Tertiary Health Institution in South-East Nigeria

Socio-Demographic Correlates of Antiretroviral Treatment Adherence among Paediatric HIV Patients Under Care at A Tertiary Health Institution in South-East Nigeria

The Relationship Between Perceived Social Support and Medication Adherence Among Adult Type 2 Diabetes Mellitus Patients Attending the Diabetes Clinic in a Tertiary Health Institution in South- South Nigeria

Purpose: Medication adherence can be defined as the extent to which a patient’s behaviour corresponds to the medication dosing regimen including time, dosing, and interval of medication intake. In chronic conditions with long-term therapies like hypertension, diabetes, depression, etc., adherence is important in achieving target outcomes but is often low. It has long been recognized that support from family, friends and significant others do play a role in helping diabetics adhere to their medication which might lead to optimal glycaemic control. This study set out to find out what influence perceived social support has, as regards medication adherence among adult type 2 diabetic Nigerians assessing care in Federal Medical Centre, Asaba, Nigeria.&#x0D; Methodology: The study was conducted on 244 participants who attended the diabetic clinic of the Federal Medical Centre, Asaba from September to November 2018. Data was collected by means of an interviewer-administered questionnaire comprising of 3 sections. Section A was for sociodemographic characteristics, section B was the 8-item Morisky Medication Adherence Scale for information on medication adherence and section C was the modified Multidimensional Scale of Perceived Social Support to collect information on perceived social support.&#x0D; Findings: All the recruited 244 participants completed the study giving a response rate of 100. The age range of the respondents was 18 to 87 years with a mean age of 51.9 ± 6.1 years. Females accounted for a higher percentage of respondents [60.2%] compared to their male counterparts [39.8%]. Good total perceived social support was significantly associated with high medication adherence [p=0.0001]. A good total perceived social support (OR = 3.27; 95% CI = 2.25 - 4.71; P = 0.0001) has 3.27 times the odds for high medication adherence than a poor total perceived social support.&#x0D; Unique Contribution to Theory, Policy and Practice: The study shows that high medication adherence is significantly associated with good perceived social support. It is important that healthcare providers caring for patients with type 2 diabetes involve families, friends, or significant others in their management so as to improve their medication adherence. Routine evaluation of perceived social support is also recommended for type 2 diabetes patients with poor medication adherence.

Challenges to sustainability of standardized nursing care plan in selected tertiary health institutions in Nigeria.

The purpose of this study was to assess the challenges to sustainability of standardized nursing care plan in selected tertiary health institutions in Nigeria. Using convergent mixed method design, the qualitative and quantitative data were collected from 427 nurses and nine stakeholders. This was done in one phase with the use of validated questionnaires and in-depth interview guide/key informant interview guide. Data were collected for 5 months and analyzed with SPSS version 25. Qualitative data were analyzed using themes. The explored significant challenges by stakeholders and nurses to sustainability of standardized nursing care plan (SNCP) in all the selected hospitals were inadequate knowledge of standardized nursing languages (SNLs), inadequate staffing, lack of motivation, lack of mandate to use SNLs by the educational system, lack of computers on the wards, weakness of previous training on SNL/SNCP, lack of interest, and high patient load. The study concludes that inadequate knowledge of SNLs and inadequate staff could contribute to non sustainability of SNCP. Nurses should be continuously trained on standardized nursing languages. Staff motivation and increasing the number of staff on the wards would increase the interest of the nursing staff. This will in turn improve the quality of documentation and patient care.