An Ethnographic Study of Palliative Care in a Nigerian Hospital

Palliative care has become an important public health issue in recent years and has been declared a universal human right. A wealth of literature can be found describing its effectiveness and numerous benefits, yet significant disparities exist in worldwide palliative care development between, and within, countries. To date, previous studies indicate that it has steadily improved in the more economically developed countries, although its utilisation remained uneven in western societies between the blacks compared with the white people. In low- and middle-income countries, palliative care has continued to be less available, underutilised and not integrated in many of the healthcare systems, especially in the African countries such as Nigeria. This qualitative study using an ethnographical approach to understand the cultural, socio-political, environmental, and organisational dynamics which influenced the provision of palliative care, and the patients’ and relatives’ behaviour towards its utilisation in a Nigerian hospital. Data was collected using participant observation, ethnographic interview and review of documentary sources, involving 43 participants, comprising healthcare professionals, members of the hospital management, patients and their families. The findings show a dominant discourse of culturally-based perceptions rooted in belief systems and inadequate knowledge of palliative care associated with insufficient education and training which manifested in several ways, such as conceptualisation of palliative care as a ‘dead end’. The service-users predominantly used their belief systems in decision-making, whereas dichotomy existed amongst the professionals about using either ethno-religious knowledge or biomedical knowledge to inform practice. These culturally-based perceptions were found to be contributory to, and a result of, a political and organisational culture that did not value palliation. Thus, the insensitivity of the bureaucrats was displayed in numerous ways, such as lack of funding for palliative care. Consequently, the environment for care represented space rather than a place that could promote the wellbeing of the service-users, which thereby contributed to various organisational cultures, such as weak interdepartmental collaboration and work-stoppage, with negative impacts for the service-users. The findings also suggest that the customary code of behaviour used by the service users was conditioned mainly by complex interactions of economic conditions, social relationships and lack of a governmental social support system. The professionals, therefore, used their personal resources as well as provided physical cash to the patients to cushion the effect of government inadequacies and to improve their wellbeing. These findings indicate the need for a cultural shift towards a mind-set that values palliative care in Nigeria in order to enhance its development. This study adds to the knowledge of this field and provides clinicians around the world with further understanding of meaning making in illness from the perspective of the Nigerian culture, which may be applicable to other people of African ancestry and could be used to boost cultural competence in palliative care

An Ethnographic Study of Palliative Care in a Nigerian Hospital

Palliative care has become an important public health issue in recent years and has been declared a universal human right. A wealth of literature can be found describing its effectiveness and numerous benefits, yet significant disparities exist in worldwide palliative care development between, and within, countries. To date, previous studies indicate that it has steadily improved in the more economically developed countries, although its utilisation remained uneven in western societies between the blacks compared with the white people. In low- and middle-income countries, palliative care has continued to be less available, underutilised and not integrated in many of the healthcare systems, especially in the African countries such as Nigeria. This qualitative study using an ethnographical approach to understand the cultural, socio-political, environmental, and organisational dynamics which influenced the provision of palliative care, and the patients’ and relatives’ behaviour towards its utilisation in a Nigerian hospital. Data was collected using participant observation, ethnographic interview and review of documentary sources, involving 43 participants, comprising healthcare professionals, members of the hospital management, patients and their families. The findings show a dominant discourse of culturally-based perceptions rooted in belief systems and inadequate knowledge of palliative care associated with insufficient education and training which manifested in several ways, such as conceptualisation of palliative care as a ‘dead end’. The service-users predominantly used their belief systems in decision-making, whereas dichotomy existed amongst the professionals about using either ethno-religious knowledge or biomedical knowledge to inform practice. These culturally-based perceptions were found to be contributory to, and a result of, a political and organisational culture that did not value palliation. Thus, the insensitivity of the bureaucrats was displayed in numerous ways, such as lack of funding for palliative care. Consequently, the environment for care represented space rather than a place that could promote the wellbeing of the service-users, which thereby contributed to various organisational cultures, such as weak interdepartmental collaboration and work-stoppage, with negative impacts for the service-users. The findings also suggest that the customary code of behaviour used by the service users was conditioned mainly by complex interactions of economic conditions, social relationships and lack of a governmental social support system. The professionals, therefore, used their personal resources as well as provided physical cash to the patients to cushion the effect of government inadequacies and to improve their wellbeing. These findings indicate the need for a cultural shift towards a mind-set that values palliative care in Nigeria in order to enhance its development. This study adds to the knowledge of this field and provides clinicians around the world with further understanding of meaning making in illness from the perspective of the Nigerian culture, which may be applicable to other people of African ancestry and could be used to boost cultural competence in palliative care

Wetland use and resource degradation among small-scale farmers in Cross River State, Nigeria

The paper examines the significance of wetland ecosystems to the socio-economic life of smallholders in Cross River State, and the relationship between socio-economic factors and wetland degradation. A multi-stage sampling procedure was used in selecting respondents for the study. Data for this study was analyzed using descriptive statistics such as means, percentages, frequency distribution and regression analysis. Findings revealed that farming was the major occupation of respondents while trading was the major complementary activity. There was evidence of increasing intensity of land use, with 51 percent of the respondents indicating 0-2 years of fallow. The wetland sector provided 80 percent employment to smallholders whereas other sectors/activities provided 20 percent. The result of the regression analysis based on Linear regression model showed that farm size, household size, respondent’s age, fallow period and level of education were all significant determinants of wetland degradation. R squared value of 0.877 implied that 88% of the variations in wetland degradation was explained by the independent variables. The adjusted R squared and Standard Error of the estimate were 86% and 6.78 respectively. The model was significant at 1% probability level. Lack of credit, lack of access to inputs and deforestation were amongst the most severe problems. The study recommends that diversification of income sources through the creation of alternative means of livelihood will help reduce pressure on wetland ecosystems and subsequently reduce wetland degradation.KEY WORDS: Wetland, Small-Scale, Resources, Ecosystem, Degradation

Human Rights of the Less Privileged Groups: Jurisprudential and Legal Issues in Global Human Rights

All human beings are born free and with equality of rights. Everyone is entitled to all the rights constitutionally guaranteed in the appropriate countries of the world. All are equal before the law and are entitled without any form of description to equal protection of the law. Articles 1, 2 & 7 of the universal Declaration of Human Rights 1948 make clear provisions to these issues. The article is aimed at articulating these human Rights issues. Keywords: Human Rights, less privileged, vulnerable groups, marginalization, jurisprudence

Comparative cost and return analysis of cassava production by adopters and non-adopters of improved cassava varieties among farmers in Ibesikpo Asutan LGA, Akwa Ibom State, Nigeria

This research is a comparative cost and return analysis of cassava production by adopters and non-adopters of improved cassava varieties among farmers in Ibesikpo Asutan LGA, Akwa Ibom State, Nigeria. A multistage sampling technique was used to select 100 respondents in a ratio of 50 adopters and 50 non- adopters. Data were collected through questionnaire and analyzed using descriptive and inferential statistics. Gross margin was carried out to estimate cost and return. Results revealed that females (68 % and 64 %) were dominant for both groups of cassava farmers. Majority (88 %) of the farmers were educated, implying that they would be more amenable to adopt technologies. The cost and return analysis shows that, total variable cost per hectare was N56,455.00 and N36,850.00 with a gross margin of N77,550.00 and N36,560.00 for adopters and non- adopters respectively, indicating that, cassava farming is profitable. Determinants of cassava production for both groups of farmers were farm size, cassava cuttings, fertilizer use and extension contact. Whereas increased farm size, cassava cuttings and extension contact significantly and positively influenced output of both groups of farmers, fertilizer use had a negative but significant influence on output of adopters, implying that fertilizer use resulted in decrease output of the adopters. The adopters are advice to discontinue the use of fertilizer. Furthermore, lack of awareness and high cost of inputs were among the major constraints to full adoption of improved cassava varieties in the study area. Therefore, it is recommended that policies aimed at improving farmer’s education and awareness should be redesign for proper implementation.Keywords: Comparative, cost and return, profitability, cassava, improved varieties, production, adopters, nonadopter

INVESTMENT IN COCOA PRODUCTION IN NIGERIA: A COST AND RETURN ANALYSIS OF THREE COCOA PRODUCTION MANAGEMENT SYSTEMS IN THE CROSS RIVER STATE COCOA BELT

The study examined costs and returns in cocoa production in Cross River State in the context of three identified management systems of cocoa production in the area, namely owner-managed, lease-managed and sharecrop managed systems, using a hundred and fifty randomly selected cocoa farmers. Results show that cocoa production is a profitable business irrespective of management system, since all of them had positive net present values (NPV) at 10% discount rate. The NPV for lease-managed farms is highest. The benefit-cost ratio (BCR) at 10% discount rate was greater than one for the three management systems, which indicates that the returns from cocoa production are high. Ownermanaged farms had the highest BCR followed by lease-managed farms in that order. Lease-managed farms were more viable compared with other management systems in terms of their high NPVs. The study surmises that given the high benefits relative to costs involved in cocoa production irrespective of management system, investments in cocoa production can be increased tremendously by providing expanded access to cheap and flexible credit and land, which have presented as limiting factors in cocoa production based on the descriptive statistical analysis in the study

MARITAL CONFLICTS AND JOB EFFECTIVENESS OF MARRIED WOMEN ACADEMICS IN TERTIARY INSTITUTIONS IN CROSS RIVER STATE

The study examined the relationship between marital conflict and job effectiveness of working married women in tertiary institutions in Cross River State, Nigeria. The survey research design was used. The population of the study was 486 married women working in four tertiary institutions in Cross River State. Using purposive sampling technique, 160 married women were drawn as sample for the study.  Data was generated through a well-structured and validated questionnaire captioned Marital Conflict and Job Effectiveness Questionnaire (MCJEQ). Cronbach coefficient Alpha reliability method was used for the test of reliability.  Reliability estimates of the sub scales of the instrument ranged from 0.613 to 0.838. Consequently, the instrument was found to be adequately reliable for use in the study. Data was analysed using descriptive statistics to answer the research question and the Pearson product moment correlation was used to test the hypotheses at 0.05 level of significance.  The result of the analysis shows that marital conflict among women in tertiary institution was perceived to be caused by late night with friends, extra-marital relationship, finances, in-law involvement and the use of mobile phone. Furthermore, there exists a significant relationship between conflict arising from child care and job effectiveness of women in tertiary institutions in Cross River State. Based on the findings, it was recommended among others that the government and other organizations (religious) should direct efforts in amelioration of marital conflicts through the psychologist and counselors in various institutions and religious institutions alike.Keywords: Marriage, conflict, women academic, job