Experiences of mistreatment among medical students in a University in south west Nigeria

Objective: This study was conducted to assess the experiences of mistreatment and harassment among final-year clinical students in a Nigerian medical school.Materials and Methods: A self-administered questionnaire was used to obtain information on the various forms of mistreatment experienced by 269 students in the 2007 and 2008 graduating classes of a medical school in Nigeria.Results: Almost all the respondents (98.5%) had experienced one or more forms of mistreatment during their training. The commonest forms experienced by the students were being shouted at (92.6%), public humiliation or belittlement (87.4%), negative or disparaging remarks about their academic performance (71.4%), being assigned tasks as punishment (67.7%), and someone else taking credit for work done by the student (49.4%). Religious or age discrimination was reported by 34.2%, sexual harassment and other forms of gender-based mistreatment by 33.8%, and threats of harm by 26.4%. These incidents were mainly perpetrated by physicians and occurred mostly during surgical rotations. The effects included strained relationships with the perpetrators, reduced self-confidence and depression.Conclusion: Most medical students experienced verbal forms of mistreatment and abuse during their training. Appropriate strategies for the prevention and reduction of medical student mistreatment should be developed

Working School Children in a Nigerian Community: Revisiting the Issues

Purpose: The prevalence, risk factors and effects of work on school performance and health consequences of child labour among school children in a rapidly urbanising community in south west Nigeria was assessed. Methods: A descriptive cross-sectional study of 386 Junior Secondary School students was conducted. Questionnaires were used to obtain information on the students’ socio-demographic characteristics, history of child labour activities, and recent history of illness. The academic records of the students were also reviewed. Results: The prevalence of child labour was 72.5%, the median number of hours spent working per week was 18 hours (range 2- 56 hours). The main reason for working was to augment the family income (37.6%). Child labour was commoner among those: whose mothers were not educated; who had four to eight siblings, and who had a working sibling. Higher proportions of working children had repeated a class and had failed the previous term’s examinations. More of the working children reported being ill and injured in the previous term. Conclusion: Child labour is quite common in this area and is associated with negative academic and health outcomes. Multidisciplinary programmes targeted at reducing the practice should be developed.Keywords: Child labour, secondary school students, south west Nigeri

The managed hypertensive: the costs of blood pressure control in a Nigerian town

Background: The health systems designed to cater for patients with chronic illnesses like hypertension have not fully evaluated the burden oflong term therapy and its effect on patient outcome. This study assessed the financial implication and cost effectiveness of hypertension treatmentin a rural Nigerian town. Methods: A chart review of 250 rural patients with primary hypertension at a regional hospital in Southwest Nigeria wasconducted. Results: The mean age of patients was 61±11.2 years, 59.2% were females, 67% had an income < .20,000 ($133.3) monthly.Diuretics and alpha-Methyl Dopa were the most prescribed drugs. The median number of prescribed drugs was two (range1-4). Mean cost oftreatment was .1440±560 ($9.6±3.7) with 52.8% spending = 10% of their income on treatment. The most cost effective therapies were MethylDopa and Diuretics with Cost-effectiveness ratios of 8 and 12.8 respectively. Patients with co-morbidities, stage 2 hypertension and those on three or four drug regimen had significantly higher treatment costs. Conclusion: The financial burden of long term antihypertensive therapy appears substantial, cost reduction strategies are needed to optimize hypertension treatment in societies with limited resources. Hypertensive management therefore requires a response adapted to the local context.Key words: Hypertensive, management, financial, cost, time, burden, Nigeria, therapy, patients, drugs, resource

Health Literacy Amongst Tuberculosis Patient in a General Hospital in North Central Nigeria

Background: Healthy literacy has been shown to improve health care access and adherence to Tuberculosis (TB) treatment. Still it remains largely unstudied in many high risks, underserved and low literacy African populations. This study aims to bridge the existing knowledge gap by assessing health literacy among patients with TB in a rural town in Northern Nigeria.Methodology: A cross sectional study was conducted among patients who attended the TB clinic of a secondary health care facility in Babura, Jigawa State, Nigeria between Oct 2008 and March 2009. All patients who visited the TB clinic during this period were interviewed.Result: Many (71.6%) reported having been educated about TB by a health worker, mostly on predisposing factors 43.2%, general facts (31.1%) and disease process (21.6%) but less on patient's role in disease management (1.4%). Functional health literacy was high; mean score was 7.9±0.3 out of 10. Knowledge about the disease process, diagnostic requirements and treatment regimen were the highest. However 97.3% felt drugs were no longer necessary once symptoms abated. Patient involvement in treatment decisions was also suboptimal as only 52.7% reported making a joint decision about drug “pick up” options with their physicians.Conclusion: Very high functional literacy score seemed to have been achieved among these rural low literacy TB patients even without a structured health literacy program. However patient participation in treatment seems to be underemphasized and was thus suboptimal. An important gap in patient education regarding continued TB treatment was identified and should be targeted for intervention.Keywords: Health Literacy, Tuberculosis, General Hospital, Nigeri

Making a case for community screening services: findings from a medical outreach in Ibadan, Nigeria

Background: Currently, population based medical check up is yet to be explored as a veritable tool for assessing the burden of on-communicable diseases in Nigeria. Objectives: This study aimed to assess the prevalence of selected lifestyle related diseases during a free medical rally in an urban community. Methods: General medical examinations of all participants at a free medical rally in a middle class community in Ibadan, Oyo State was conducted. Body Mass Index (BMI), blood pressure and random blood sugar measurements were done using standardised instruments. BMI classification for children was done using the CDC guidelines for males and females aged 2-20 years. Results: Of the 302 participants examined, 33.1% were males and 32.1% were less than 18 years. Of those aged 2 to 20 years, 22.9% were underweight, while 5.2% were overweight/ obese. In adults 3.6% were underweight and 43.2% were overweight/ obese. Adults were significantly more likely to be overweight/obese (P<0.001). Prevalence of high blood pressure was 29.3% and 9.4% of adults had elevated random blood glucose levels. A higher proportion of obese people (P=0.259), males (P= 0.327) and those older than 40 years (P<0.001) had elevated blood pressure. A weak correlation (spearman rho= 0.3) was found between blood pressure and BMI (P<0.001) and also between BMI and blood sugar level (spearman rho= 0.2) P=0.05. Conclusion: There is a need for greater emphasis on community based screening programmes to aid early diagnosis and treatment of non communicable diseases in the country

Prevalence, awareness, treatment, and control of hypertension in Nigeria in 1995 and 2020: A systematic analysis of current evidence

Improved understanding of the current burden of hypertension, including awareness, treatment, and control, is needed to guide relevant preventative measures in Nigeria. A systematic search of studies on the epidemiology of hypertension in Nigeria, published on or after January 1990, was conducted. The authors employed randomeffects meta-analysis on extracted crude hypertension prevalence, and awareness, treatment, and control rates. Using a meta-regression model, overall hypertension cases in Nigeria in 1995 and 2020 were estimated. Fifty-three studies (n = 78 949) met our selection criteria. Estimated crude prevalence of pre-hypertension (120-139/80-89 mmHg) in Nigeria was 30.9% (95% confidence interval [CI]: 22.0%-39.7%), and the crude prevalence of hypertension (≥140/90 mmHg) was 30.6% (95% CI: 27.3%-34.0%). When adjusted for age, study period, and sample, absolute cases of hypertension increased by 540% among individuals aged ≥20 years from approximately 4.3 million individuals in 1995 (age-adjusted prevalence 8.6%, 95% CI: 6.5-10.7) to 27.5 million individuals with hypertension in 2020 (age-adjusted prevalence 32.5%, 95% CI: 29.8-35.3). The age-adjusted prevalence was only significantly higher among men in 1995, with the gap between both sexes considerably narrowed in 2020. Only 29.0% of cases (95% CI: 19.7-38.3) were aware of their hypertension, 12.0% (95% CI: 2.7-21.2) were on treatment, and 2.8% (95% CI: 0.1-5.7) had at-goal blood pressure in 2020. Our study suggests that hypertension prevalence has substantially increased in Nigeria over the last two decades. Although more persons are aware of their hypertension status, clinical treatment and control rates, however, remain low. These estimates are relevant for clinical care, population, and policy response in Nigeria and across Africa

Supplementation of micronutrients in community micronutrient deficiency prevention programmes

Micronutrient deficiency affects about 2 billion people all over the world. The major micronutrient deficiencies which are of public health importance include vitamin A, iron and iodine deficiencies. The deficiencies of these micronutrients cause a variety of morbidities and increased mortality which are most severe in children, adolescent girls and pregnant women. Despite the magnitude of these deficiencies, research has shown thatthey are correctable using simple strategies. This review examines the strategies employed to reduce micronutrient deficiencies worldwide by reviewing bibliographic databases, monograms and journals up tothe year 2007. These strategies include food based and micronutrient supplementation. Although micronutrient supplementation is widely embraced as a strategy to combat micronutrient deficiencies, they are most suitable when used as a measure to combat severe deficiencies.Food based strategies such as food fortification and dietary diversification are more effective than micronutrient supplementation which should only be used as a short term measure. Supplementation programmes should be evidence based, multi-nutrient in approach and backed up with other complementary public health interventions.Keywords: Supplementation, iron, vitamin A, iodine, combined strateg

Evaluating the Medical Care of Child Sexual Abuse Victims in a General Hospital in Ibadan, Nigeria

Objectives: Evaluation of the medical care provided to victims of Child Sexual Abuse (CSA).Design: A retrospective cross sectional study.Setting: The general outpatient clinic of a 150 bed secondary health care facility in Ibadan, NigeriaParticipants: Children < 18 years who were treated as Victim’s sexual assault.Main Outcome measure: Investigations and treatment prescribed for CSA victims.Results: The median age of victims was 12 years (range 3-17 years). All were females and 33.3% had attained menarche. Many (68.1%) had torn hymen; of these, 16.3 % also had vaginal lacerations and bleeding.Children>10 years more often had torn hymen (P<0.001). Vaginal swab microscopy was done in 84.0% of those with torn hymen. About 60% of victims had retroviral screening done (all were non reactive) the retroviral screening of the perpetrator was requested in only case. None of the patients received post exposure prophylaxis for HIV. Of those with signs ofvaginal penetration who had also attained menarche 12.2% had emergency contraceptives prescribed. Treatment of victims consisted mostly of antibiotics -47.2% and analgesics- 37.5% with only 15.3% of patients proffered any form of counselling.Conclusions: There is a still a huge gap between the health care needs of victims of CSA and the medical services provided for victims of CSA. The use of a treatment protocol and additional training for health care providers in the management of CSA victims is encouraged

Hospital-acquired infections in a Nigerian tertiary health facility: An audit of surveillance reports

Background: Hitherto efforts to implement data driven prevention guidelines for hospitalacquired infections (HAI) in Nigeria have been limited by the inadequate knowledge of the risks of these infections. This study evaluated the occurrence of HAI in a foremost tertiary health facility over a 5-year period for the purpose of reinforcing control efforts.Materials and Methods: A retrospective survey of records from the infection control unit of the University College Hospital, Ibadan, Nigeria, was done for the years 2005-09. For the 5 years studied 22,941 in-patients were reviewed and the data of those who developed infections during admission were retrieved and analyzed. The prevalence, types, and causative organisms of HAI were determined. The chi-square test was used to evaluate associations. Results: The prevalence of HAI over the 5-year period was 2.6% (95% CI: 2.4–2.8). Surgical and medical wards had the most infections (48.3%) and (20.5%) respectively. Urinary tract infection (UTI) and surgical site infection (30.7%) were the most prevalent (43.9%) HAI. UTIs were significantly higher in surgical and medical wards, surgical site infections in obstetrics and gynecology wards, and soft tissue infections and bacteremia in pediatric wards (P<0.05). Gram-negative infections occurred about four times as often as gram-positive infections with Klebsiella sp. and staphylococcus aureus being the predominant isolates (34.3%) and (20.1%) respectively. Conclusion: Efforts to limit HAI should be guided by local surveillance data if progress is to be made in improving the quality of patient care in Nigeria.Key words: Hospital-acquired infections, infection control, Nigeria, surveillanc