An Assessment of Mental Health Status of Undergraduate Medical Trainees in the University of Calabar, Nigeria: A Cross-Sectional Study

BACKGROUND: The mental health status of medical students has been proven to be poor compared to their peers in other disciplines and has led to grave personal and professional consequences. This subject has however remained largely unexplored in our medical school.AIM: The study was therefore conducted to assess the prevalence of mental health of medical students in the University of Calabar, Cross river state, Nigeria.METHODOLOGY: A descriptive cross-sectional survey of 451 randomly selected medical students from the pre-clinical and clinical levels of study in the University of Calabar. A self administered questionnaire including the GHQ12 was used to elicit information from the respondents. A score of ≥ 3 suggested poor mental while a score < 3 represented good mental health. Data were summarized using proportions, and c2 test was used to explore associations between categorical variables. Level of significance was set at p < 0.05.RESULTS: The mean age of the respondents was 23.4 ± 4.3 years, 63.8% were males, 34.8% were from the preclinical and 65.2% from clinical levels of study. Based on the GHQ categorisation, 39.2% had a poor mental health status, compared to 60.8% with good mental health status. The factors significantly associated with poor mental health, were recent experience of mistreatment by trainers or colleagues, perceived inadequate monthly allowance and perception that medical training is stressful (p < 0.05).  CONCLUSION: With more than a third of undergraduate medical trainees with traits of poor mental health, provision of accessible mental health services/counselling is strongly recommended early in their training

Breast Evaluation Findings in Calabar, Nigeria

BACKGROUND:  X-ray and sonomammography constitute a significant option in the early detection and management of breast diseases in the developed world. Unfortunately these modalities became available in Nigeria, only in the past few decades.AIM: The aim of this audit is therefore to document the imaging findings, in the past three years in a developing facility in Nigeria relating them with the demograghic features.METHODS: We prospectively studied the x-ray and sonomammography in all patients, presenting over a three year period, for breast evaluation with the hope of discerning the epidemiologic pattern of breast lesions in this environment.RESULTS: One hundred and forty-five females and four males. Median was 38 years (IQR=30-48). The commonest reason for evaluation was screening. Patients that were below 38 years showed no significant difference in frequency and type of lesion compared with patients over 38 years. The commonest breast pattern was fatty replaced. The upper outer quadrant was the commonest site.CONCLUSION: Patients presenting for breast evaluation in Calabar do so for screening mainly. Patients below 38 are nearly equally affected by malignant breast disease as their older counterparts. The commonest breast pattern was fatty replaced. Digital mammography should be available in all tertiary institutions

Hepatitis B Virus Knowledge and Vaccination Status among Health‐care Workers in Calabar, Nigeria

Background and Objectives: The World Health Organization estimates that 2 million health‐care workers (HCWs) are at risk of occupational exposure to hepatitis B virus (HBV), with the majority (90%) of such infections arising in sub-Saharan Africa. This study aimed to determine HBV knowledge and vaccination uptake among HCWs. Materials and Method: This was a cross sectional analytical study conducted among 392 HCWs from two major health institutions in Calabar i.e. the University of Calabar Teaching Hospital (UCTH) and the General Hospital Calabar (GHC), Cross river State. Multi-staged sampling method comprising of two stages was used to recruit participants into the study. The study population comprised of doctors, nurses, laboratory scientists/technologist, and other categories of HCWs such as pharmacists, ward orderlies, and mortuary attendants. A semi-structured self-administered questionnaire was used to obtain data on the socio-demographic characteristics of HCWs, the knowledge of HCWs regarding HBV and vaccine. The analysis of data was done using the Statistical Package for Social Sciences version 20. Study Design: This was a cross-sectional, study of HCWs in Calabar. Sampling Method: Multi-staged sampling method was used to select participants from two major health institutions in Calabar, i.e., the University of Calabar Teaching Hospital (UCTH) and the General Hospital Calabar (GHC). Thereafter, through balloting, simple random sampling technique was used to recruit the participants. Study Population: Three hundred and ninety-two HCWs were recruited from UCTH and GHC under the following categories: doctors, nurses, laboratory scientists/technologist, and other categories of HCWs such as pharmacists, ward orderlies, and mortuary attendants. Data Management: A semi-structured self-administered questionnaire was used to obtain data on the socio-demographic characteristics of HCWs, the knowledge of HCWs regarding HBV and vaccine. The analysis of data was done using the Statistical Package for Social Sciences version 20. Results: Overall, 67.9% of the respondents were found to have adequate knowledge of HBV vaccination and infection. Less than half (43.4%) of HCWs admitted receiving three doses (i.e., full coverage) of the vaccine. Difficulty in accessing the vaccine (48, 23.4%) was identified as the major reason given for suboptimal vaccination. Conclusion: The knowledge of HBV infection and vaccination is quite modest among HCWs in Calabar. Despite this observation, the vaccination status among HCWs is unsatisfactory. The implication of the findings of our study for health policy and practice is to prevent further occupational exposure of HCWs to HBV infection through mandatory vaccination

Using the COMMVAC taxonomy to map vaccination communication interventions in Mozambique

Improved communication about childhood vaccination is fundamental to increasing vaccine uptake in low-income countries. Mozambique, with 64% of children fully vaccinated, uses a range of communication interventions to promote uptake of childhood immunisation.; Using a taxonomy developed by the 'Communicate to Vaccinate' (COMMVAC) project, the study aims to identify and classify the existing communication interventions for vaccination in Mozambique and to find the gaps.; We used a qualitative research approach to identify the range of communication interventions used in Mozambique. In-depth semi-structured interviews were carried out with key purposively selected personnel at national level and relevant documents were collected and analysed. These data were complemented with observations of communication during routine vaccination and campaigns in Nampula province. We used the COMMVAC taxonomy, which organises vaccination communication intervention according to its intended purpose and the population targeted, to map both routine and campaign interventions.; We identified interventions used in campaign and routine vaccination, or in both, fitting five of the seven taxonomy purposes, with informing or educating community members predominating. We did not identify any interventions that aimed to provide support or facilitate decision-making. There were interventions for all main target groups, although fewer for health providers. Overlap occurred: for example, interventions often targeted both parents and community members.; We consider that the predominant focus on informing and educating community members is appropriate in the Mozambican context, where there is a high level of illiteracy and poor knowledge of the reasons for vaccination. We recommend increasing interventions for health providers, in particular training them in better communication for vaccination. The taxonomy was useful for identifying gaps, but needs to be more user-friendly if it is to be employed as a tool by health service managers

Perceptions and experiences of childhood vaccination communication strategies among caregivers and health workers in Nigeria: a qualitative study

Effective vaccination communication with parents is critical in efforts to overcome barriers to childhood vaccination, tackle vaccine hesitancy and improve vaccination coverage. Health workers should be able to provide information to parents and other caregivers and support them in reaching decisions about vaccinating their children. Limited information exists regarding the perceptions of caregivers and health workers on the vaccination communication strategies employed in Nigeria. This study, which forms part of the 'Communicate to vaccinate' (COMMVAC) project, aims to explore the perceptions and experiences of caregivers and health workers in Nigeria on vaccination communication strategies implemented in their settings.; We conducted the study in two States: Bauchi in Northern Nigeria and Cross River in the south. We carried out observations (n = 40), in-depth interviews (n = 14) and focus group discussions (FGDs) (n = 12) amongst 14 purposively selected health workers, two community leaders and 84 caregivers in the two states. We transcribed data verbatim and analysed the data using a framework analysis approach.; Caregivers were informed about vaccination activities through three main sources: health facilities (during health education sessions conducted at antenatal or immunization clinics); media outlets; and announcements (in churches/mosques, communities and markets). Caregivers reported that the information received was very useful. Their preferred sources of information included phone text messages, town announcers, media and church/mosque announcements. Some caregivers perceived the clinic environment, long waiting times and health worker attitudes as barriers to receiving vaccination information.When delivering communication interventions, health workers described issues tied to poor communication skills; poor motivation; and attitudes of community members, including vaccine resistance.; Communication about vaccination involves more than the message but is also influenced by the environment and the attitudes of the deliverer and receiver. It is pertinent for health policy makers and programme managers to understand these factors so as to effectively implement communication approaches

Dating and Digging Stratified Archaeology in Circumpolar North America : A View from Nunalleq, Southwestern Alaska

The results presented in this paper were funded by a NERC Radiocarbon Facility grant (NRCF 1917.0415), while the wider project is funded by the Arts and Humanities Research Council (AH/K006029/1). The authors wish to thank all the members of the excavation crew from the 2014 field season for their hard work in the challenging weather conditions of southwest Alaska – without their attention to detail this study would not have been possible. Additional thanks are also due to Qanirtuuq Incorporated for logistical support and warm hospitality in Quinhagak. We also wish to thank Kevin Edwards and Kate Britton, who read an earlier draft of this paper, and three anonymous reviewers for highly constructive criticism that helped us to improve the final manuscript.Peer reviewedPublisher PD

Identification of preliminary core outcome domains for communication about childhood vaccination : an online Delphi survey

Communication interventions for childhood vaccination are promising strategies to address vaccine hesitancy, but current research is limited by the outcomes measured. Most studies measure only vaccination-related outcomes, with minimal consideration of vaccine hesitancy-relevant intermediate outcomes. This impedes understanding of which interventions or elements are effective. It is also unknown which outcomes are important to the range of stakeholders affected by vaccine hesitancy. Outcome selection shapes the evidence base, informing future interventions and trials, and should reflect stakeholder priorities. Therefore, our aim was to identify which outcome domains (i.e. broad outcome categories) are most important to different stakeholders, identifying preliminary core outcome domains to inform evaluation of three common vaccination communication types: (i) communication to inform or educate, (ii) remind or recall, and (iii) enhance community ownership.; We conducted a two-stage online Delphi survey, involving four stakeholder groups: parents or community members, healthcare providers, researchers, and government or non-governmental organisation representatives. Participants rated the importance of eight outcome domains for each of the three communication types. They also rated specific outcomes within one domain ("attitudes or beliefs") and provided feedback about the survey.; Collectively, stakeholder groups prioritised outcome domains differently when considering the effects of different communication types. For communication that aims to (i) inform or educate, the most important outcome domain is "knowledge or understanding"; for (ii) reminder communication, "vaccination status and behaviours"; and for (iii) community engagement communication, "community participation". All stakeholder groups rated most outcome domains as very important or critical. The highest rated specific outcome within the "attitudes or beliefs" domain was "trust".; This Delphi survey expands the field of core outcomes research and identifies preliminary core outcome domains for measuring the effects of communication about childhood vaccination. The findings support the argument that vaccination communication is not a single homogenous intervention - it has a range of purposes, and vaccination communication evaluators should select outcomes accordingly

Childhood Vaccination Communication in Nigeria: A qualitative study

Good communication about vaccination is key to increasing children’s vaccine uptake. However, governments rarely give communication strategies sufficient attention or design them systematically. Using qualitative approaches, this thesis provides insight into how vaccination information is being communicated in Nigeria and identifies factors affecting the implementation of communication strategies. The thesis shows that most vaccination communication strategies aimed to inform and educate parents and to remind and recall them about appointments. However, common health system barriers to implementation included funding and human resources constraints, inadequate equipment and weak political will. Political support, engagement of traditional and religious institutions and the use of organized communication committees appeared to facilitate communication activities. Barriers identified by parents were clinic-related while health workers reported poor interpersonal communication skills, poor motivation, and the attitudes of community members. Effective vaccination communication will require addressing the barriers that currently hamper the implementation of evidence informed strategies

Breast Evaluation Findings in Calabar, Nigeria

Abstract BACKGROUND: X-ray and sonomammography constitute a significant option in the early detection and management of breast diseases in the developed world. Unfortunately these modalities became available in Nigeria, only in the past few decades

Septic Arthritis: A Need to Strengthen the Referral Chain in a Developing Economy

ABSTRACT Aim: This retrospective analysis documents the features and factors that potentially affect outcomes in septic arthritis in the Cross River Basin area of south-south Nigeria. Patients and Methods: A retrospective analysis of 43 patients who presented with septic arthritis in 45 joints between September 2007 and August 2010. All patients with pain, fever, joint swelling and non-weight bearing/refusal to move the limb and had a joint aspiration productive of a turbid and/or purulent aspirate were included in the analysis. Patients whose joint aspiration produced frank blood or a clear exudate were excluded. Results: There were 24 males and 19 females (M:F = 1.3:1). Forty patients were children while three were adults. Thirty-three patients were urban dwellers, 8 were semi-urban dwellers and 2 were rural dwellers. Twenty-five children were first seen by a Paediatrician. Only 5 patients were first seen by an Orthopaedic surgeon. Definitive treatment was conservative in 28 children and arthrotomy/washout in 12 children and 3 adults. Staphylococcus aureus was the commonest isolated pathogen in both age groups. Conclusion: Injudicious interventions in musculoskeletal conditions consist not only of traditional bone setting and other unorthodox practices, but also sub-optimal orthodox medical practices. Healthcare outcomes in Africa are a function of the skewed distribution of the healthcare workforce and a weak referral chain. The near absence of follow-up culture underscores the need for education on injudicious antibiotic therapy to be directed at patients and physicians. Judicious interventions in musculoskeletal sepsis at first contact and a strengthening of the referral chain are important