The paradigms of public health practice: Lessons for disciplinary public health and community physicians in the developing countries

Background: Public health (PH) is the application of any science or art  organizationally, for the prevention of one, a few, or several diseases; as well as the promotion of health, happiness and longevity for the people at large; and efficiently. Most of these fall within the responsibility of the government to its polity; but in the modern world, individuals and groups of public-spirited people are also getting  involved in these. Many paradigms for the practice of public health exist – the  government (public) health services on the one hand and the other vertical public health services, covering only sanitary/environmental health or other non-clinical public health sub-specialties; preventive medicine, social medicine; or community medicine and health, and primary health care as well.Problems: Because of the two ways of entering into the public health service, disciplinarily by primary post-professional direct and full-PH or partial  specializations therein; or by the ordinary entry into the government (public health services) or by entry into any of the above six different paradigms of its practice; there is often a misunderstanding of the entire meaning, practices, relations and efficient running of these public health services.This paper is therefore a review of these two modes of entrance and practice of PH, the distinction and relationships between all the six paradigms of practice thereof, and the benefits as well as problems associated with them. It proffers some  suggestions as to their containment, especially for the disciplinary public health physicians as the ultimate community physicians in that most efficient practice paradigm of PH. The same applies also to the disciplinary public health nurse-midwives, similarly, as the statutory district or zonal community nurse-midwives

Determinants of choice of health facility for reproductive morbidity by female traders in a Nigerian city

Background: Reproductive health (RH) services are important to reduce reproductive morbidity and mortality. This is only possible if such services are used. Knowledge of the determinants of choice health facility for reproductive morbidity is useful to design interventions aimed at increasing utilization of RH services.Objective: This study therefore explored the determinants of choice of health facility for reproductive morbidity among female traders within Ibadan metropolis.Methods: This was a cross-sectional study using interviewer-administered questionnaire among 410 female traders aged 15-49 years selected by systematic random sampling in Aleshinloye market in the city of Ibadan, Nigeria. Government and private hospitals were classified as orthodox health facilities. Data was analysed using logistic regression at 5% significance level.Results: Mean age was 34.6 ± 7.8, 78.2% were married and 58.7% had secondary education. Above half (52.9%) used orthodox health facilities. Perceived quality of care influenced the use of orthodox facilities and likelihood of using the same facility in the future. Factors predicting the use of orthodox health services were social economic status (OR 2.77 95%CI 1.06-6.73), delay in attaining conception (OR 2.70 95%CI 1.39-5.22), menstrual problems (OR 2.15 95%CI 1.19-3.90) and complications in previous pregnancy (OR 2.11 95%CI 1.21-3.78).Conclusion: The use of orthodox health facilities was affected by respondents’ past experience of reproductive morbidity and socioeconomic status. These factors should be borne in mind in planning interventions for improvement in reproductive health service utilisation.Keywords: Reproductive morbidity, Orthodox healthcare services, Healthcare seeking behaviour, Female traders, Nigeri

Job satisfaction and psychological health of bankers in Calabar, Nigeria

Background: Satisfied employees tend to be healthier and more productive. There is no known study on the overall job satisfaction and psychological health of bank employees in Nigeria.Objective: To assess the level of job satisfaction and its relationship to psychological health among bank employees in a southern city of Nigeria.Design: A cross-sectional descriptive survey.Setting: Commercial Banks in Calabar, Nigeria.Subjects: Professional employees engaged in core Banking activities.Results: Response rate was 75%. About half (52.6%) reported overall job satisfaction. The most commonly mentioned reason for job dissatisfaction was lack of promotion. About one third of respondents were at increased likelihood of having a psychological disorder. There was a statistically significant negative correlation between job satisfaction and GHQ scores. Satisfied respondents were least likely to have psychological disorder.Conclusion: About half of the bank employees were satisfied with their jobs. A negative correlation was found between job satisfaction and psychological health of these workers. Causes of job dissatisfaction should be addressed by employers of labour to improve job satisfaction, psychological health and productivity

Determinants of job satisfaction among physicians in public hospitals in Calabar, Nigeria

Background: Little is known about organizational factors and personal  characteristics that affect job satisfaction among health care providers in  sub-Saharan Africa. The aim of this study was to identify the determinants of job satisfaction among physicians in Calabar.Methods: A descriptive cross-sectional survey was conducted among all 157  eligible and consenting physicians who had worked for at least six months in three public hospitals in Calabar. Data collection tool was a pretested self-administered questionnaire that also contained a section on job satisfaction assessment with both single-item and Spector multi-item Job Satisfaction Survey. Overall job  satisfaction was assessed as the dependent variable using a single-item  satisfaction measure. Domain-specific satisfaction was assessed as independent variables using the Spector Job Satisfaction Survey (JSS) instrument and adapted items from the Netherlands Working Conditions Survey. Data analysis was conducted using SPSS 14.0. A mutivariate logistic regression model for overall job satisfaction was developed.Results: Majority (68.2%) were males. The mean age of the respondents was 32.8 ± 5.4 years. In the logistic regression model, the variables that independently  predicted overall job satisfaction among respondents included: pay (AOR= 6.43, 95% CI= 1.17-35.27), contingent reward (AOR= 12.28, 95% CI= 1.18-127.97), operating procedures (AOR= 3.62, 95% CI= 1.03-12.67), communication (AOR= 3.07, 95% CI= 1.25-7.5), job autonomy (AOR= 3.70, 95% CI= 1.03-13.30), and being married (AOR= 5.43, 95% CI= 1.52-15.23).Conclusion: This study identified satisfaction with pay, contingent reward, operating procedures, communication, job autonomy and being married as determinants of overall job satisfaction among doctors in public hospitals in Calabar, Nigeria.Keywords: Job satisfaction; Organizational factors; Personal characteristics; Physicians

Job satisfaction, health and psychosocial wellbeing among medical doctors in public hospitals in Calabar, Nigeria: a qualitative study

Objective: The aim of the study was to assess job satisfaction, health and psychosocial wellbeing of doctors in public hospitals in Calabar using indepth qualitative method.Methods: Two focused group discussions were conducted among male and female resident doctors. Doctors were selected purposively giving considerations to departments, hierachy and the hospitals. Doctor selection also involved the three major public hospitals in Calabar and five different departments/specialties. A focus group discussion guide was used to direct discussion and a digital audio recorder was used to record discussion with permission from participants. A research assistant also took notes during the sessions. The discussions were transcribed from the audio recorder and compared with the notes taken. Thematic analysis was done and narratives of the discussion was reported.Results: Participants expressed general satisfaction with their work. Reasons expressed for job dissatisfaction from some participants included poor salary, inadaquate tools and consumables, and dissatisfaction with level of training from consultants. Areas of the work environment in which discussants were most satisfied included opportunities for learning and career development, appreciation from patients and patients' relatives. Least satisfaction was derived from high level of mortality in a department, inadequate tools to work with, poor facilities, poor supervision, poor coworkers perception of their specialities, and inability to rest after calls. Regarding health, discussants suffered headaches, backaches, malaria, social stress from being away from family, inadequate sleep, and fear of patient assault.Conclusion: Hospial managment could improve doctors' job satisfaction by carrying out regular and adequate maintenance of hospital facilities and provide ergonomically suitable environment for resident doctors. Clinical team leads could also improve the opportunities for engagement with their subordinates.Keywords: Healthcare provider satisfaction, thematic analysis, hospital management, psycho-social work environmen

Prevalence and determinants of stunting among primary school children in rural and urban communities in Obafemi Owode Local Government Area, Southwestern Nigeria

Background: Studies on stunting in children have largely focused on the underfive, establishing it as a strong predictor of mortality in these children. Few studies have documented the prevalence or determinants of stunting among school children in southwestern Nigeria. The aim of the study was to determine the prevalence and predictors of stunting among selected primary school children in rural and urban communities of Obafemi Owode Local Government Area, Ogun State.Methods: A cross-sectional study of rural and urban primary school children was conducted. An interviewer-administered questionnaire was used to collect information on respondents’ and parents’ socio-demographic characteristics. Stunting was defined as height-for-age less than two standard deviations from the median height-for-age of the standard World Health Organization reference population. Using EPI-INFO version 6.03, children were classified as stunted if zscores of height-for-age were less than 2 standard deviations below the National Centre for Health statistics (NCHS)/WHO median. Height and weight were taken using a stadiometer and weighing scale respectively. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) Version 16.0 while predictors were determined using logistic regression at 95% level of significance.Results: A total of 1,160 primary school children were studied with 52.2% from rural schools. Males constituted 57.1% and 51.8% in the rural and urban school respectively. Prevalence of stunting among rural school children was 46.2%, and was significantly higher (p<0.001) than among urban children at 33.8%. Younger children <10 years (OR: 0.088; 95CI: 0.052 - 0.150) and children between 11-12 years (OR: 0.534; 95CI: 0.322 - 0.886) were at a significantly lower risk of stunting both in rural schools compared to children >13 years.Conclusion: The prevalence of stunting was high especially among pupils from schools in the rural communities. This underscores the need for urgent feasible and effective nutrition programs for primary school children especially those in rural schools within the study area.Keywords: Stunting, School children, Undernutrition, Millennium development goals, Sustainable development goal

Prevalence and Correlates of Reproductive Morbidity among Female Traders in Ibadan Nigeria

Background: Efforts to mobilise resources for reproductive health services require data on common reproductive morbidities which constitute a significant proportion of global ill-health among women of reproductive age. This study assessed the prevalence and correlates of reproductive morbidity among female traders of reproductive age in Ibadan, Nigeria.Methods: Using systematic random sampling, 410 female traders aged 15-49 years were selected and data collected with interviewer-administered structured questionnaires in a cross-sectional study at a major Ibadan market. Univariate, bivariate and multivariate analysis were done using SPSS version 23.0 and WINPEPI version 11.65 at 5% significance level.Results: The respondents’ mean age was 34.6±7.8 years and 223 (58.7%) had secondary education. Most 349 (91.8%) had experienced reproductive morbidity, of which 279 (79.9%) had gynaecologic morbidities with menstrual problems (273; 97.8%) being the commonest; 262 (75.1%) had obstetric morbidities among whom 221 (84.4%) had pregnancy complications while 185 (53.0%) experienced intimate partner violence (IPV). Women aged 30-39 years had lower odds of any reproductive (OR=0.27; 95% CI=0.08–0.89) and obstetric morbidities (OR=0.18; 95% CI=0.10–0.31) while those ≥40years had twice the odds of gynaecologic morbidity (OR=2.18; 95% CI=1.22–3.90) as those <30 years. The odds of IPV and of experiencing any reproductive morbidity reduced with increasing wealth status.Conclusion: Reproductive morbidity is common among traders in Ibadan. Obstetric and gynaecological morbidities were commoner among older women while higher wealth status was a protective factor. Reproductive health interventions should prioritise older and poorer women as at-risk groups for gynaecological interventions. Keywords: Reproductive morbidity; Female traders; Pregnancy complications; Menstrual problems; Intimate partner violence; Ibada

Tobacco cessation services and related challenges among dentists in southwest Nigeria

Introduction: Oral health problems arising from tobacco use have been reported and some of these conditions can be prevented through Tobacco Cessation (TC). Dentists are well positioned to provide tobacco cessation services to patients. In Nigeria, little is documented on the provision of cessation services among dentists and the challenges. This study was conducted to assess the cessation practices of dentists and their related challenges in Southwest Nigeria.Methods: A cross sectional study was carried out in all the tertiary healthcare facilities within the six states of the Southwest geopolitical zone. A total population survey involving dentists below the cadre of Consultant/Chief Dental Officers undergoing postgraduate training and/or providing services in the tertiary hospitals was conducted using a pretested semi structured selfadministered questionnaire. This included questions on challenges experienced in the provision of TC services in their respective facilities.Results: A total of 224 eligible dentists were approached to participate in this study with a response rate of 91.5%. Mean age and completed years of working experience were 33.8±5.2 and 6.1±4.4 respectively. In reporting challenges to  implementing tobacco cessation services, 60% of respondents reported ‘lack of perceived efficacy and training’ as the major barriersConclusion: From this study, incorporation of tobacco cessation into the dental curriculum will increase the knowledge and competence of dentists. Provision of systems support to dentists willing to help patients quit smoking may be important in ensuring the health system is responsive to the tobacco control needs of patients in Southwest Nigeria.Keywords: Tobacco cessation, Dentists, Challenges, Nigeri

Knowledge and practice of universal precautions against blood borne pathogensamongst house officers and nurses in tertiary health institutions in southeast Nigeria

To examine the knowledge and practice, as well as factors influencing universal precautions practices amongstNigerianHouse officers andNurses. A Cross-sectional descriptive study. Sample selection was by stratified random sampling. Information was elicited using pretested, structured, self-administered questionnaire. Data were analyzed usingEPI-info. Most Doctors, 66.6%,were aged 26-30 years while the Nurses, 41.1%,were aged 40 years. 57.6% of the Doctors were males, while 85.7% of the Nurses were females. Knowledge of universal precautions measures was high for both categories of respondents - 97.0% for doctors and 92.0% for nurses, although practice was better for the nurses, 75.0%, compared to the doctors, 15.2%, p < 0.05. Themost important factor influencing universal precautions practice is the lack of provision of adequate protective equipments. Other factors, all of which show significant difference between the doctors and nurses (p < 0.05), include carelessness; lack of display of universal precautions guidelines; emergency nature of the procedure; insufficient water supply; patient perceived to be at low risk of blood borne pathogens; pressure of time; and universal precautions equipments interferingwith technical skills. Although knowledge of universal precautions is high for both house officers and nurses, practice is however better amongst the latter than the former. The effective knowledge and practice of universal precautions amongst hospitalworkers are of absolute necessity to prevent infections fromblood and body fluid pathogens.Keywords: Nigeria; knowledge and practice; universal precautions; healthcare workers; tertiary health institutions

Understanding the introduction and use of a mobile device-supported health information system in Nigeria

Copyright @ 2014 The Authors.This paper presents an in-depth analysis of efforts to introduce a mobile health information system in Nigeria as part of a development initiative aimed at improving maternal and child health. Specifically, it examines the use of mobile devices to facilitate maternal health information accessibility and exchange among health practitioners in order to reducing maternal, newborn and child mortality. Further, it also looks at the challenges raised while introducing mobile devices into work practices in the healthcare sector. The study adopts a case study approach, relying on semi-structured interviews and document analysis as its main methods for collecting data. The specific case examined is a mobile phone-based information system introduced to support a national government effort in Nigeria, known as the midwives service scheme. The findings of this study show that this integrated approach of using mobile phones to support (health) information systems has vast potential; for instance increasing the timeliness of (health) data available to stakeholders for monitoring and planning purposes. However, we also find that over time, attaining the potential of development efforts such as this remains difficult as initiatives involving the use of mobile devices is not just about getting the technical aspect right. It is equally dependent on deep seated social-cultural influences such as poor political and financial commitment. These two mutually reinforcing influences have been identified in this study as significant impediments to efforts of this kind. Therefore, this paper argues for, first a strong political commitment across all levels of government whereby their words are backed with action. Second it is important that the government maintains financial integrity by releasing the funds budgeted to support the smooth running of these efforts, for such initiatives to thrive and ultimately contribute to development