Determining Factors for the Choice of Medical Career among the Final Year Medical Students of a Private University in Nigeria

Background: Medical education worldwide is more expensive compared to other university courses due to the structure of the training into two phases: basic medical sciences and clinical sciences, each with extensive syllabuses and involves an array of professionals in various specialties. The burden of medical education was largely borne by the government in Nigeria until recently when the private sector forayed into the provision of tertiary education including medical education. Methods: The study was a cross‑sectional survey study. All 94 final year medical students of Afe Babalola University, Ado‑Ekiti, a private sector‑owned university in South Western Nigeria, were invited to participate in the study. The institutional ethical approval was sought and obtained (ERC/2020/04/07/364A). Structured self‑administered questionnaires were used to collect relevant data. Participation in the study was voluntary and confidential. The data obtained were analyzed using SPSS version 20.0 (SPSS Inc., Chicago, IL, USA). Results: Eighty‑three (88%) final year medical students participated and returned completed questionnaires out of 94 students. Further analyses  were on the number of the respondents (n = 83). Fifty‑seven (68.7%) of the respondents were female, whereas 26 (31.3%) of the respondents were male. The mean standard deviation age was 23 (1.6) years, and the age ranges between 20 and 30 years. Parental influence and personal interest were the two most important factors that influenced the decisions for medical education. Fifty‑seven (68.7%) of the respondents prefer to practice outside Nigeria, 25 (30.1%) respondents will like to practice in Nigeria but in urban areas, whereas only 1 (1.2%) of the respondents will prefer to practice in a rural area. Conclusion: The choice of medical education and future specialty is multifactorial but the most important factors are personal interest and parental influence. The choice of where to practice is mostly determined during the undergraduate program, and it tends toward continuous emigration of doctors to developed countries. Keywords: Medical education, medical students, Nigeria, postgraduate specialty, private universit

Surgical Outreach as a Tertiary Hospital’s Corporate Social Responsibility: Shall we do more?

Introduction: The underserved populations of the rural and suburban communities of developing countries are challenged by the twin hurdles of low-income earning and out-of-pocket payment for surgical care services. This study aims at appraising the process, outcome, and impact of a free surgical outreach programme carried out by a Federal Teaching Hospital in South-western Nigeria. Methods: A free day-case surgical outreach programme was announced through a popular radio jingle for a period of 1 week to attract would‐be beneficiaries of the programme. A 2-day screening exercise was conducted by the concerted efforts of various specialists in the department of surgery and ophthalmology to select those who are suitable for day-case surgery. Across-sectional survey of patients who participated in the 5-day surgical outreach programme was carried out. A structured questionnaire was used to obtain information on biodata, diagnosis, surgical operations, complications, and level of satisfaction. A 3‐point bipolar satisfaction outcome scale was used to assess the level of satisfaction. The data obtained were analyzed using the SPSS software version 20.0. Results: One hundred and fifty‐eight patients were screened, but only 124 participated. Ophthalmic cases constituted 60.5%, whereas the rest (39.5%) were non-ophthalmic cases. Patients with cataract were 73 (58.9%) of all the surgical lesions operated during the outreach programme. Two (1.6%) patients with pterygium were the other ophthalmic cases, whereas the non-ophthalmic cases were mainly hernias. A total of 129 surgical operations were performed in the 124 patients, with 5 (0.4%) of them having bilateral cases. One hundred and seventeen patients (94.4%) expressed satisfaction with their experience of the programme. Conclusions: Optimal corporate social responsibility of tertiary hospitals can be performed effectively and satisfactorily through a properly organized surgical outreach

Psychological, Socioeconomic Effects of COVID-19 Pandemic and Associated Prevalent Self-Reported Vulnerability Factors among Residents of Southwest Nigeria

Background: Infectious diseases wrecked havoc in global economies, especially when outbreak or pandemic occurs. The present  COVID‑19 pandemic has not only caused disruption to global activities but also of businesses, trades, movements, and academic activities. Southwest Nigeria has the highest burden of COVID‑19 of all the six geopolitical zones in the country. This study, therefore, aims at determining the psychological, socioeconomic effect of COVID‑19 pandemic and associated vulnerability factors among residents of Southwest Nigeria.Methods: This survey is a cross‑sectional study in the six southwest states of Nigeria via Google questionnaire sent electronically to obtaininformation from respondents. Targeted sampling and snowball techniques were used to reach the respondents. Data were analyzed using SPSS 23, and the level of statistical significance was at P < 0.05. Results: The mean age of the respondents is 32.89 ± 9.59 years and age range of 16–57 years. Majority of the respondents were males, married with tertiary education. Majority (83.9%) of the respondents have severe psychological effects, 78.2% have their family income affected, while diabetes, asthma, cardiovascular diseases, cancers,  previous contact with a confirmed case and travel history outside Nigeria were among the self‑reported vulnerable factors of COVID‑19.  Conclusion: The study concluded that the psychological and economic effects of COVID‑19 are high in Southwest Nigeria and major self‑reported vulnerable factors include cardiovascular diseases, diabetes, asthma, and cancers. Scale‑up of public awareness,  subsidization of personal protective equipment, and financial stimulus are recommended measures against the disease. Keywords: COVID‑19, effect, Nigeria, vulnerabilit

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Implementing the 2013 WHO diagnostic criteria for gestational diabetes mellitus in a Rural Nigerian Population

Introduction: the World Health Organization (WHO) reviewed the threshold values required for the diagnosis of Gestational Diabetes Mellitus (GDM) in 2013 and the implementation of the new diagnostic criteria have been associated with increase in the prevalence of GDM in some populations. The new cohort of pregnant women that will be labeled to have GDM by the 2013 WHO diagnostic criteria but not by the 1999 WHO diagnostic criteria will pose additional burden to specialized antenatal care, though their pregnancy outcome may not warrant such care. It is thus important to first determine the effect of the implementation of these new consensus diagnostic criteria on the prevalence of GDM in our environment. Methods: this is a prospective hospital-based study that compared the implementation of both 1999 and 2013 WHO GDM diagnostic criteria among 117 pregnant women who were initially screened with 50-gram Glucose Challenge Test (50-g GCT). Women with a positive Glucose Challenge Test (GCT) result underwent a 75-gram Oral Glucose Tolerance Test (75-g OGTT), which was used as the actual diagnostic test for GDM using both 2013 WHO and 1999 WHO diagnostic criteria. Associations between variables were tested using Chi-square, Fisher's exact and t-test as appropriate. Significance level was set at P value < 0.05. Results: the prevalence rates of GDM in the study were 2.6% and 7.7% for 1999 WHO and 2013 WHO criteria respectively. Clinical characteristics were similar in women with GDM and women without GDM. The fasting component of the OGTT identified all the women with GDM. Conclusion: the implementation of the 2013 WHO diagnostic criteria is associated with a 2.5 to 3-fold rise in the prevalence of GDM. Selective risk-factor based screening may be clinically irrelevant with the adoption of the 2013 WHO diagnostic criteria. A minimum of fasting plasma glucose in resource poor settings can be considered to identify women with GDM since it appeared to have 100% sensitivity in our study

Influence of Family Dynamics on Medication Adherence among Hypertensive Patients in a Tertiary Hospital in South-West Nigeria

INTRODUCTION Hypertension is an overwhelming global challenge estimated to cause 7.5 million death, which is about 12.8% of all deaths.1 The emerging pandemic of non-communicable diseases (NCDs) is creating major health challenges worldwide. Of the 56 million global deaths in 2012, 38 million (68%) were attributed to NCDs, with almost three quarters (74%) of these deaths occurring in low and middle income countries.2 Indeed, it is estimated that up to three-quarters of the world's hypertensive population will be in economically developing countries by the year 2025.3,4 Nigeria, like most other developing countries is undergoing epidemiological transition and faces the double burden of communicable and noncommunicable diseases.3,4 Of the latter, hypertension is one of the most important treatable causes of morbidity and mortality

Papanicoleau Smear Usage and Prevalence of Premalignant Cervical Lesion among Women Living with HIV Attending a Federal Teaching Hospital in South-West Nigeria: A Comparative Study

Aim: Cancer of the cervix is the third most common cancer among women worldwide, and in Nigeria it is the second most common female cancer. Infection with the Human immunodeficiency virus (HIV) is associated with an increased risk of prevalent, incident and persistent squamous intraepithelial lesions (SILs) of the cervix. The aim was to determine the level of awareness of cervical cancer screening test and the development of premalignant cervical lesions among HIV positive women. Study Design: A Hospital based comparative cross-sectional study. Place and Duration of the Study: The study was carried out in the HIV clinic and general outpatient clinic of Federal Teaching Hospital Ido-ekiti, Ekiti state Nigeria. It was carried out from July to September 2015. Methodology: The study was carried out among 65 HIV-positive and 65 HIV-negative women. Data were collected from the interviewees. Participants also had Pap smear. Data collected were analyzed using statistical package for social sciences version 19. Results: The mean age was 39.73 (±8.57) and 40.98 (±10.68) among the HIV positive and negative women respectively. Only 27.7% of the HIV-positive women compared to 56.9% of the HIV negative women had heard of cervical cancer with P= 0.001. The level of awareness of cervical cancer screening test was 15.4% and 50.8% among the HIV positive and negative women respectively (P= 0.001). The prevalence of premalignant cervical lesions among the study and control groups was 26.2% and 16.9% respectively. This showed that premalignant cervical lesion was more prevalent among HIV-positive women though not statistically significant (P=0.201). However, using risk ratio (RR), the risk of developing cervical lesions is 1.55 times more in HIV exposed women than HIV negative women. Conclusion: There is therefore need for the Physicians to use every opportunity to counsel their clients on the need for routine cervical cancer screening especially in adult HIV clinics

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population