Global competencies in family medicine

Introduction:This project was devised to provide a global snapshot of required national competencies in Family Medicine, and is the result of an international collaboration of the International Fellowship of Primary Care Research Networks (IFPCRN). The Research team, which devised the questionnaire and original list of competencies, was drawn from around 30 countries and 15 countries responded to the questionnaire and contributed national data. These countries however represented close to two thirds of our global population and included Low, Middle and High Income countries (based on World Bank Purchasing price Parity (PPP) 2005) as well Parity (PPP) 2005) as well as representing a good cross section of climatological, socio economic and geographical situations. Aims and Objectives: To compile a list of competencies required of global family doctors, via global consultation, and use them in the form of a questionnaire to survey national family medicine representatives to ascertain if family doctors are required to be competent in these disciplines. The Objective is to provide a ‘global snapshot’ of competencies and trends in family medicine Materials and Methods: A representative list of family medicine competencies was compiled by an International Fellowship of Primary Care Research Networks (IFPCRN) group, from 30 countries over a 3-month period, commencing June 2009. A list of 57 expanded items, and 44 core items was then compiled and formed the basis of a questionnaire, with provision for adding additional competencies that did not appear in the list of 57. This was broadcast by list server to the IFPCRN email group. Results: 15 Family medicine/ primary care representatives completed the survey on behalf of their nation (or region in the case of West Africa). Results showed a trend toward a globally standard curriculum but still much variation in competencies taught

Bacterial Bloodstream Infections in HIV-infected Adults Attending a Lagos Teaching Hospital

An investigation was carried out during October 2005–September 2006 to determine the prevalence of bloodstream infections in patients attending the outpatient department of the HIV/AIDS clinic at the Lagos University Teaching Hospital in Nigeria. Two hundred and one patients—86 males and 115 females—aged 14-65 years were recruited for the study. Serological diagnosis was carried out on them to confirm their HIV status. Their CD4 counts were done using the micromagnetic bead method. Twenty mL of venous blood sample collected from each patient was inoculated into a pair of Oxoid Signal blood culture bottles for 2-14 days. Thereafter, 0.1 mL of the sample was plated in duplicates on MacConkey, blood and chocolate agar media and incubated at 37 °C for 18-24 hours. The CD4+ counts were generally low as 67% of 140 patients sampled had <200 cells/μL of blood. Twenty-six bacterial isolates were obtained from the blood samples and comprised 15 (58%) coagulase-negative staphylococci as follows: Staphylococcus epidermidis (7), S. cohnii cohnii (1), S. cohnii urealyticum (2), S. chromogenes (1), S. warneri (2), S. scuri (1), and S. xylosus (1). Others were 6 (23%) Gram-negative non-typhoid Salmonella spp., S. Typhimurium (4), S. Enteritidis (2); Pseudomonas fluorescens (1), Escherichia coli (1), Ochrobactrum anthropi (1), Moraxella sp. (1), and Chryseobacterium meningosepticum. Results of antimicrobial susceptibility tests showed that coagulase-negative staphylococci had good sensitivities to vancomycin and most other antibiotics screened but were resistant mainly to ampicilin and tetracycline. The Gram-negative organisms isolated also showed resistance to ampicillin, tetracycline, chloramphenicol, and septrin. This study demonstrates that co-agulase-negative staphylococci and non-typhoidal Salmonellae are the most common aetiological agents of bacteraemia among HIV-infected adults attending the Lagos University Teaching Hospital, Nigeria. The organisms were resistant to older-generation antibiotics often prescribed in this environment but were sensitive to vancomycin, cefotaxime, cefuroxime, and other new-generation antibiotics

Pre-Vaccination Nasopharyngeal Pneumococcal Carriage in a Nigerian Population: Epidemiology and Population Biology

Initiative (AVI) of the Global Alliance for Vaccines and Immunisation (GAVI). However, country data on the burden of pneumococcal disease (IPD) is limited and coverage by available conjugate vaccines is unknown. This study was carried out to describe the pre vaccination epidemiology and population biology of pneumococcal carriage in Nigeria. Methods: This was a cross sectional survey. Nasopharyngeal swabs (NPS) were obtained from a population sample in 1

Bacterial bloodstream infections in HIV-infected adults attending a Lagos Teaching Hospital

An investigation was carried out during October 2005-September 2006 to determine the prevalence of bloodstream infections in patients attending the outpatient department of the HIV/AIDS clinic at the Lagos University Teaching Hospital in Nigeria. Two hundred and one patients-86 males and 115 females-aged 14-65 years were recruited for the study. Serological diagnosis was carried out on them to confirm their HIV status. Their CD4 counts were done using the micromagnetic bead method. Twenty mL of venous blood sample collected from each patient was inoculated into a pair of Oxoid Signal blood culture bottles for 2-14 days. Thereafter, 0.1 mL of the sample was plated in duplicates on MacConkey, blood and chocolate agar media and incubated at 37\ubaC for 18-24 hours. The CD4+ counts were generally low as 67% of 140 patients sampled had &lt;200 cells/\u3bcL of blood. Twenty-six bacterial isolates were obtained from the blood samples and comprised 15 (58%) coagulase-negative staphylococci as follows: Staphylococcus epidermidis (7), S. cohnii cohnii (1), S. cohnii urealyticum (2), S. chromogenes (1), S. warneri (2), S. scuri (1), and S. xylosus (1). Others were 6 (23%) Gram-negative non-typhoid Salmonella spp., S. Typhimurium (4), S. Enteritidis (2); Pseudomonas fluorescens (1), Escherichia coli (1), Ochrobactrum anthropi (1), Moraxella sp. (1), and Chryseobacterium menin-gosepticum. Results of antimicrobial susceptibility tests showed that coagulase-negative staphylococci had good sensitivities to vancomycin and most other antibiotics screened but were resistant mainly to ampicilin and tetracycline. The Gram-negative organisms isolated also showed resistance to ampicillin, tetracy-cline, chloramphenicol, and septrin. This study demonstrates that co-agulase-negative staphylococci and non-typhoidal Salmonellae are the most common aetiological agents of bacteraemia among HIV-infected adults attending the Lagos University Teaching Hospital, Nigeria. The organisms were resistant to older-generation antibiotics often prescribed in this environment but were sensitive to vancomycin, cefotaxime, cefuroxime, and other new-generation antibiotics

Knowledge, attitude, and practices of emergency health workers toward emergency preparedness and management in two hospitals in Lagos

Background and Objective: The Emergency Department is of significance and is the vital entry points of patients into the healthcare facility of the hospital all around the world. This study aims to assess the knowledge, attitude and practices of emergency personnel at two tertiary hospitals in Lagos as regards emergency management and preparedness. Aims: This study aims to assess the knowledge, attitude, and practices of emergency personnel at two tertiary hospitals in Lagos with regard to emergency management and preparedness. Settings and Design: This was a descriptive, cross-sectional study. Materials and Methods: A convenient recruitment was made of eligible and consenting individuals at both hospitals until the required sample size was reached. Statistical Analysis Used: The data obtained were analyzed using Epi Info statistical software version 3.5.1. Results: The majority (93.2%) of the participants were clinicians. It was discovered that less than half or 98 (47.8%) of the participants had good knowledge of emergency preparedness and planning, 76 (37.1%) had a fair knowledge, while 31 (15.1%) had poor knowledge. The respondents' attitude toward emergency preparedness was generally positive, as most of them, that is, 191 (93.2%) believed that they needed to know about emergency planning. Only a minority, that is, 72 (35.1%) of the respondents knew that emergency drills are done in their respective hospitals. Conclusions: There was an overall deficiency in the respondents' knowledge of emergency preparedness. Their attitude was good and acceptable, but their practices in terms of the frequency of emergency drills and the frequency of regularly updating the emergency plans were grossly inadequate

Fattening "Nkuho" as Instrument of Women Empowerment and Fertility Control Among Calabar Women in Nigeria

This paper presents some qualitative results of an extensive study on reproductive health. The geographical area of study was Calabar in South East Nigeria where the total fertility rate was found to be 2.4, which was less than the national average of 6.5. Certain practices were identified which might have contributed to this low fertility rate. These practices included the fattening culture, a monogamous marital life style, women empowerment through early education and the socio-political integration of women, prolonged breastfeeding, strong abhorrence of premarital sex and other practices that encouraged marital harmony as well as proper child care. Other undesirable practices like killing of twins were also prevalent. Today, abortions, vesico-vaginal fistulae, unwanted pregnancies and abandoned babies, which were hitherto rare, now constitute areas of concern among the people. This study was conducted to explore and describe the experiences of women on the fattening room practices as an instrument of empowering women's reproductive rights. Qualitative study of 28 women was done. Narratives and indepth interviews was used among four (4) geriatric women aged 65-80 years who underwent fattening room experience /exposure with a Quettelet index of over 35 Focus group discussions with 24 middle aged family planning nurses who had never experienced the process but had been briefed by their mothers, took part in the study The fattening room practices have been abandoned since the beginning of the Nigerian civil war from 1966-70 but some beneficial effect on health had been identified which should be encouraged as a starting point for culturally sensitive reproductive right education Key Words: Fattening room, Qualitative studies, reproductive rights Nig. Medical Practitioner Vol. 44(2) 2003: 43-4

Preference for private hospital-based maternity services in inner-city Lagos, Nigeria: An observational study

Objectives To determine factors associated with maternal preference for delivery in private hospitals in an urban community in sub-Saharan Africa.Methods A cross-sectional study of socio-demographic and obstetric characteristics of mothers and their newborns attending Bacille Calmette-Guérin (BCG) immunization clinics in inner-city Lagos, Nigeria. Factors associated with delivery in private hospitals were determined using multivariable logistic regression analyses.Results Of the 3296 mothers enlisted for this study 1659 (50.3%) delivered in private hospitals and 1637 (49.7%) in public hospitals. Government hospitals had a higher proportion of doctors at delivery. Use of private obstetric services was significantly associated with ethnicity, religion, social class and obstetric history. Infants delivered at private hospitals were significantly more likely to be undernourished and have severe hyperbilirubinemia but less likely to be preterm and at no greater risk of hearing loss.Conclusions Current global strategies to expand facility-based deliveries in order to reduce maternal and child mortality rates need to be complemented by improved regulatory/supervisory framework at country levels to better serve mothers and their offspring in urban areas who may opt for private hospitals usually lacking adequate obstetric and pediatric facilities against the backdrop of the rapid urban transition in Africa.Maternal health Urban health Health-seeking behavior Immunization clinics Developing country

Uptake of hepatitis B vaccination among staff of an accident and emergency facility in Lagos, southwest Nigeria

Background: Hepatitis B vaccine has been available since 1982; it is safe and 95% effective in the prevention of chronic infection in adults and children. People with reasonable exposure to blood and blood products (health workers and those in accident and emergency facilities) ought to be vaccinated against Hepatitis B. Materials and Methods: A descriptive cross-sectional study was carried out among the staff of an accident and emergency facility in Lagos, southwest Nigeria. A pretested, structured, and self-administered questionnaire was used for collection of data on the sociodemographic characteristics and the uptake of hepatitis B vaccination among the respondents. The uptake was based on whether the respondents had received the vaccine, the number of doses received (i.e., whether complete or not), and whether they were undergoing a postvaccination test. The responses on the uptake of hepatitis B vaccination was scored and graded as good (≥50%) and poor (<50%). Results: A total of 84 respondents participated in the study. The majority of them (84.5%) had poor uptake of hepatitis B vaccination and the mean uptake score (%) was 24.2 ± 25.0. Among the respondents, 47 (56.0%) had received at least a dose of the hepatitis B vaccine, 11 (13.1%) received the three complete doses, while only 7 (9.9%) did a postvaccination test to check immune status. Among the 37 respondents who did not receive any dose of the vaccine before the study was carried out, a majority of them (67.6%) cited nonavailability of the vaccine as the reason for this while four (10.8%) cited cost as the reason. Conclusion: The uptake of hepatitis B vaccination among the staff of the accident and emergency facility was poor mainly due to nonavailability of the vaccine. There is, therefore, a need for the government to provide this vaccine and make it available at an affordable cost for workers. In addition, an immunization policy should be put in place at the facility, and implementation and monitoring should be done to ensure that the staff are immunized and protected against the hepatitis B virus (HBV)