Radiographers’ willingness to work in rural and underserved areas in Nigeria: a survey of final year radiography students

Background: Radiographers are in great demand and inadequate distribution to the rural hospitals and underserved areas affect prompt health service delivery to patients. Patients travel several kilometres from rural and underserved areas in Nigeria to access radiographic services and this affects morbidity and mortality.Objective: To assess factors associated with Radiographers’ willingness to practice in rural and underserved areas in Nigeria.Methods: The study adopted a cross sectional survey. A total of 124 final year students from Southern Nigeria in Departments of Radiography in two tertiary institutions in Southeast Nigeria participated in the study. A researcher-developed questionnaire was the instrument for data collection. The questionnaire elicited questions on willingness to work in rural and underserved areas based on socio-demographic characteristics,remunerations, security, working conditions, peculiar incentives, extrinsic and intrinsic motivations.Results: A total of 27 % of the student radiographers showed strong willingness, 32 % showed weak willingness and 41 % showed unwillingness to practice in the rural and underserved areas in Nigeria. Age, sex, remuneration, peculiar allowances and security were strongly associated with willingness to practice in rural and underserved areas (p < 0.05). Love for patient care, job satisfaction, provision of accommodation and opportunity for professional development had weak association (p > 0.05) with willingness to practice in rural and underserved areas.Conclusion: Greater number of the student Radiographers were not willing to practice in rural areas ofNigeria. Areas of insurgency, some parts of northern Nigeria, primary and secondary healthcare centres located outside the major cities were unlikely to attract young energetic radiographers. Males and older respondents were more likely to work in rural and underserved areas of the country. There is need for adequate planning and provision of social incentives if radio-diagnostic services will be adequately covered in the national program for universal health coverage in Nigeria

Artefactual Behaviour of Fluid in Radiographic Darkroom Practice

Background: Before the advent of computed and digital radiography, radiographs were processed in a lighttight darkroom. In spite of advancement in technology which enables film processing without the intermediary of the conventional darkroom, many radiographic centres worldwide, especially in developing countries like Nigeria, still carry out darkroom processing. Liquid chemicals are involved, and their misuse may result in artefacts on the processed radiographs. Objective: To investigate the artefactual abilities of common darkroom fluids on x-ray films (unprocessed) and radiographs (processed) in a centre transiting from darkroom to computed radiography.Methods: A total of five thousand, five hundred (5,500) radiographs produced between January to June 2013, and retrieved from the archive were scrutinized retrospectively, with the aid of a viewing box until those withfluid-induced artefacts were identified and isolated. The nature, grayscale appearance and origin of artefacts were arrived at by consensus of the researchers and documented. Divergence in opinion or ambiguous artefacts was resolved through darkroom simulations. Data was analyzed with a simple calculator. Results: Sixty-one (1.1 %) radiographs with fluid-induced artefacts were noted. Developer caused black artefacts while fixer, water and grease all caused different hue of grey artefacts. Only grease caused artefacts after processing whereas other fluids were inert on them. Water-induced artefacts, as a result of stuck films in the automatic processor had the highest frequency (n = 21; 34.4 %) while water-bed artefact was rare (n = 1; 2 %). The stages at which artefacts were introduced were noted as pre-processing, processing and postprocessing, respectively.Conclusion: All four investigated darkroom fluids are potential artefactual agents. A knowledge of their distinct characteristics on films and radiographs may help to reduce distractions during reporting, as well as serve as guide to effective remedial actions during subsequent darkroom processing

Assessment of Radiation Safety Measures in Select Radio-Diagnostic Centres in Kaduna State, Nigeria

Background: The risks associated with x-rays in radiography are minimized through international best practices of a regular program of quality control. Objective: To assess the radiation safety precautions taken in five radio-diagnostic centers in Kaduna State, NigeriaMethodology: Measuring tapes, radiation meters and other accessories were used to assess for x-ray room dimension, x-ray tube leakage, kVp accuracy, half value layer (HVL), mA linearity, optical and x-ray beam congruence, beam alignment, and timer accuracy. Results: Only one centre complied with the 16m2 minimum room dimension required for an x-ray room, passed area monitoring without a compromise, and wholly complied with kVp error limit of 5%. Two centres passed optical radiation beam congruence, beam alignment and timer accuracy tests. Three centres passed mA linearity test. All the five centers passed the tube leakage test with none of the centers recording up to 1mSv/h at 100cm from the tube surface. Conclusion: X-ray machines used in Kaduna States are safe. However, there are uncoordinated attention toother safety precautions. More efforts should be made to ensure that holistic regulatory standards are met in order to consolidate radiation protection

A Survey of Structural Design of Diagnostic X-ray Imaging Facilities and Compliance to Shielding Design Goals in a Limited Resource Setting

Purpose: To survey structural designs of x-ray rooms and compliance to shielding design goals of three x-ray imaging facilities. Methods and Materials: The survey was conducted in three radiodiagnostic centers in South East Nigeria, labeled X, Y and Z for anonymity. A stretchable non-elastic meter rule was used to measure x-ray room dimensions. A Vernier caliper was used to measure lead thickness while a calibrated digital survey meter Radalert 100x was used for radiation survey of controlled and uncontrolled areas. Simple statistical tools such as mean and standard deviation were used for analysis with the aid of Microsoft Excel version 2007. Results: Center X had a room dimension of 2.4 m × 2.1 m, Center Y had an x-ray room dimension of 3.6 m × 3.3 m, and Center Z had two x-ray rooms with identical dimensions of 6.3 m × 3.6 m. Measured exit radiation doses for controlled areas in all the centers were: 0.00152 mSv/wk; 0.00496 mSv/wk; 0.00168 mSv/wk; 0.00224 mSv/wk respectively. Lead was the common shielding material used. Conclusion: Based on the parameters studied, Center Z had the ideal room size and layout. Relative distances from the x-ray tubes to the nearest walls were not optimized in all the centers except in Center Z. Measured exit doses were within recommended limits except in Center Y. The location of the control consoles and measured doses were appropriate and within recommended design goals

Computed Tomography Scanner Distribution and Downtimes in Southeast Nigeria

Background: It is clearly known and documented that the first computed tomography (CT) scanner was installed in 1987 at the University College Hospital (UCH) Ibadan, Southwest-Nigeria. Ironically, it is neither clearly documented how many more scanners have been installed after then, nor about their functionality. Objective: To establish the actual number and functionality of CT scanners in the Southeast geopolitical zone of Nigeria.Methodology: The survey was undertaken from March – June, 2016. Radiographers across different tertiary hospitals in southeast (SE) Nigeria, were requested through phone calls to ascertain the number of CT scanners in their respective states of residence. Their feedback was crosschecked using entirely different Radiographers. Internet searches were conducted to authenticate some information obtained. For Anambra State where all but one of the authors worked or schooled, physical visits were made to all centres. Data elicited covered scanner specifications, installation details, ownership, and functionality, amongst others. These were recorded in a pro forma sheet and later collated and presented in tables. Result: A total of 23 CT centres with 28 CT scanners were confirmed. These were distributed across the zone as follows: Anambra; 10 (35.8 %), Imo; 6 (21.4 %), Enugu; 6 (21.4 %), Abia; 4 (14.3 %) and Ebonyi; 2 (7.1 %). Private ownership accounted for 19 (68.0 %) of the scanners while the remaining 9 (32.0 %) were distributed between the Federal Government (n = 5; 18.0 %), public-private partnership (n = 2; 7.0 %), and state governments (n = 2; 7.0 %), respectively. Appropriate personnel were engaged in the facilities. Majority of the scanners were installed in the current decade (2006 – 2016). At least 12 (43.0 %) of the scanners experienced downtime within the period of the survey with 7 scanners having downtime ≥ 1 year. Conclusion: There are 23 radiodiagnostic facilities with 28 CT scanners in the Southeast zone of Nigeria. Five facilities each own two scanners. There appears to be a good distribution of CT scanners with appropriate personnel. A high downtime rate was observed, suggesting the need for the employment of centre-based CT engineers, to ensure that CT patients have as prompt an access as can be achieved

Thyroid volume by ultrasound in asymptomatic gravid and non-gravid controls in a negroid population in Nigeria

Background: The thyroid gland is among the most commonly imaged glands using ultrasound due to the limitation of clinical examination. During pregnancy, thyroid volume responds physiological to the increased demands for iodine and energy. An enlargement of the thyroid gland during gestation is, therefore, not abnormal. However, this may be confused for goiter, which the World Health Organization (WHO) and the International Council for the Control of Iodine Deficiency Disorders have recommended to be investigated through ultrasound.Objective: To establish a local reference volume of the thyroid gland in asymptomatic pregnant women that could be used to define goiter in the context of iodine deficiency disease monitoring. People and Methods: A total of 430 volunteers made up of 399 pregnant women and 31 nonpregnant female control were recruited prospectively and purposively. After obstetrics scan with a 3.5 MHz curvilinear transducer, the subject’s thyroid gland was subsequently scanned with a 7.5 MHz linear transducer. The cranio‑caudal, antero‑posterior, and transverse diameter of each lobe represented the length, height, and width, respectively. These were subsequently multiplied with a WHO‑recommended correction factor (0.479) to derive the volume. A summation of the volumes of both lobes gave the total thyroid volume for each subject.Results: The mean thyroid volumes (±standard deviations) in pregnant women and nonpregnant controls were 8.26 ± 4.17 cm3 and 2.54 ± 0.46 cm3, respectively. The mean for the first to third trimesters were 5.17 ± 1.83 cm3, 7.81 ± 2.44 cm3, and 11.81 ± 4.53 cm3, respectively. A one‑way analysis of variance showed significant differences in the mean thyroid volumes within the three trimesters (P = 0.000).Conclusion: The wide variation in thyroid volume between pregnant women and nonpregnant controls points to the possibility of deficient dietary iodine intake during gestation in our locality. Special attention on daily minimum iodine intake for gravid women as recommended in other countries is advised.Keywords: Pregnant women, thyroid, ultrasound, volum

The impact of COVID-19 and associated shocks on Agri Food SMEs along the poultry and fish value chains in Kebbi State, Nigeria

This policy research note presents the key findings from a study on the impact of COVID-19 and associated policies on SMEs along the poultry and fish value chains in Kebbi State

Computed tomography scanner census and adult head dose in Nigeria

Background: Inspite of potential detriment from computed tomography (CT) procedures, there is increasing installation and use of the medical imaging modality in Nigeria. Computed tomography dose monitoring and reporting have however, not received commensurate attention. Objective: To carry out a census of CT scanners in Nigeria and, to assess a representative sample for dose. Methodology: A physical count of the scanners was done using radiographers spread across the country. Twenty of those scanners were then assessed for head dose using volume computed tomography dose index (CTDIvol), and dose-length product (DLP) extracted retrospectively and manually from the operating console. The mean, as well as the 75th percentile, were then calculated for all subjects with the aid of statistical packages for the social sciences (SPSS), version 20.0. Results: A total of 183 CT scanners were installed in Nigeria as at March 2018. A huge number of these (57.4%, n = 105) belonged to private investors while the federal and state governments jointly owned 78 scanners (42.6%). The Christian-dominated South had far more scanners installed (n = 116) than the Muslim-dominated North and FCT (n = 67). Three states in northern Nigeria had no single scanner installed. A sizeable number (83%, n = 151) of the scanners were functional as at March 2018. The CT dose was assessed using scanners from General Electric (GE), Toshiba, Philips, Siemens and Neusoft. CereTom was the only model left out due to low distribution and inaccessibility. The slice capacity ranged from 4 to 128. Tube potential was uniform (120 kVp) in the centres while tube current was within a narrow range (200–250 mA). The dose for head investigation amongst the adult population had a mean/75th percentile of 57/63 mGy (CTDIvol) and 1336/1431 mGy·cm (DLP), respectively. This is fairly comparable to a similar work from Kenya but higher than the recommendations of the European Commission. Conclusion: Computed tomography scanners distinctly located in Nigeria were 183. The first installation in the country was in 1987, suggestive of an annual average of 6 installations. Dose from different facilities showed wide variations. The establishment of national diagnostic reference levels (nDRLs) to reduce arbitrariness in dose administration is imperative. While this is awaited, radiographers have a moral and ethical obligation to pay more attention to optimization of patient protection. Keywords: CT scanners, Dose, CTDI, DLP, Optimization, CT censu

PIVOTING IN NIGERIA’S FISH AND POULTRY VALUE CHAINS IN RESPONSE TO COVID-19 POLICIES AND IMPACTS

This report uses a panel dataset from two phone surveys covering February–October 2020 and March– July 2021, with nearly 500 small and medium enterprises (SMEs) in the fish and poultry value chains of eight states in all six of Nigeria’s geopolitical zones. We address three empirical gaps in the knowledge of the impacts of COVID-19 and containment policies on enterprises in these value chains