Healthcare Education in Nigeria: Evolutions and Emerging Paradigms

The above book published by Professor Joseph Balogun, an accomplished clinician, researcher, educator, and administrator, who doubled as a participant-observer while working on this book, is a compelling masterpiece. As a former Senior Lecturer and Vice-Dean at Obafemi Awolowo University, Ile-Ife three decades ago, a retired Distinguished Professor at Chicago State University, faculty, and administrator at several universities around the world, made Professor Balogun uniquely qualified to author this book. He is familiar with the global education and healthcare systems. As a patriotic Nigerian who has devoted his life to giving back to his homeland, Professor Balogun authored this book to address the curriculum deficits he observed during one of his many visits to Nigeria. At a national workshop he gave at the University of Medical Sciences, Ondo City in 2018 to faculty, heads of academic departments, and university administrators, he observed that most of his audience had no formal training on their roles and responsibilities

Physicians and AIDS care: does knowledge influence their attitude and comfort in rendering care?

Adequate knowledge, positive attitude, and feeling of comfort are important factors in providing compassionate care to patients. The purpose of this study was to assess physicians' knowledge, attitude and global comfort in caring for patients with AIDS (PWA), to determine the sociodemographic variables that could influence physicians' attitude and global comfort, and to identify any relationship between their knowledge, attitude and comfort. Consultants and residents (N=211) in two Nigerian teaching hospitals were surveyed using a two-part questionnaire. Part I elicited sociodemographic and previous AIDS encounter information, and Part II assessed knowledge, attitude and global comfort with AIDS patients care. Nigerian physicians showed satisfactory knowledge, but they harbored negative attitude and low level of comfort in caring for PWA. Previous AIDS care experience, age and being a consultant or a senior resident influenced attitude, while male gender and knowing someone with AIDS influenced global comfort. Knowledge is weakly but positively associated with attitude, while attitude is modestly associated with comfort. The study reinforced the need for an ongoing education focused on experiential learning, and professional socialization in order to influence physicians' attitude and enhance their feeling of comfort when caring for PWA. African Journal of Health Sciences Vol. 14 (1-2) 2007: pp. 37-4

Comparison of cardiovascular responses following self-selected maximal effort in forward, backward and sideways walking

Humans learned to walk forward in the course of evolution, while sideways and backward walking are considered to be novel tasks. This study compared the cardiovascular parameters during forward, backward and sideways walking of students in a Nigerian University. Fifty apparently healthy young adult students (25.6±2.0 years) were purposively recruited to participate in the study. Participants had their anthropometric characteristics (weight and height) and cardiovascular parameters (heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP], pulse pressure (PP) and rate pressure product (RPP), and rate of perceived exertion [RPE]) determined at baseline. Participants’ HR, SBP, DBP, MAP and RPE responses after a 100 meter walk at the subject’s self-selected maximum speed during the different modes of walking were compared using multiple analysis of variance. Significantly higher DBP, MAP (P<0.05) and RPE (P<0.01) for sideways walking compared to backward walking, higher (P<0.01) HR, SBP and RPE for both sideways walkingand backward walking compared to forward walking, and higher (P<0.01) HR, SBP, DBP, MAP and RPE for sideways walking compared to forward walking were found. We also found higher (P<0.01) HR, SBP and RPE for backward walking compared to the corresponding values during forward walking. Overall, findings of heightened cardiovascular responses suggest higher energy expenditure in sideways walking compared to forward and backward walking. We hypothesize that the differential plane of motion and the more prevalent static muscle workin sideways walking may be responsible for the apparently more strenuous nature of sideways walking compared to the other modes.Keywords: Cardiovascular; Energy expenditure; Ambulation; Walking; Motor patter

Test-retest reliability of IPAQ environmental- module in an African population

<p>Abstract</p> <p>Background</p> <p>There is overwhelming evidence of the benefits of physical activity and the physical environment is increasingly recognized as a promising determinant of physical activity participation. The influence of the environment on physical activity has not been evaluated among black Africans and no specific measure exists for assessing environmental factors related to physical activity in an African environment. The IPAQ E- module was designed to assess environmental factors for physical activity participation and was considered to be relevant to all countries regardless of the stage of economic development. The objective of this study was to assess the test- retest reliability of IPAQ E- module in an African population.</p> <p>Methods</p> <p>One hundred and three clinical students of a University in Nigeria were invited to participate in the reliability testing of IPAQ E- module. Sixteen of the 17- items on the environmental measure were assessed for test- retest reliability using intraclass correlation coefficient (ICC) with 95% Confidence interval (CI) overall and by gender. The measure addressed items regarding residential density, access to destinations, neighborhood infrastructures, aesthetic qualities, social environment, street connectivity and neighborhood safety.</p> <p>Results</p> <p>Of the total respondents, 51.5% were males and 48.5% were females. Overall, the intraclass correlation coefficient (ICC) ranged from 0.43 to 0.91. The item regarding many interesting things to look at (aesthetic) produced the overall highest reliability score (ICC = 0.91, 95% CI = 0.86 – 0.94), while the item regarding safety from crime during the day (neighborhood safety) produced the lowest overall score (ICC = 0.43, 95% CI = 0.26 – 0.57). Reliability of items on neighborhood infrastructures ranged between substantial agreement to almost perfect agreement overall (ICC = 0.66 – 0.88) and by gender (male- ICC = 0.68 – 0.90 and female- ICC = 0.63 – 0.86). The access to destination items (ICC = 0.49 – 0.74), social environment (ICC = 0.62) and street connectivity (ICC = 0.78) all had acceptable reliability overall. Meaningful differences were found between males and females on two items on neighborhood safety and one item on access to destinations.</p> <p>Conclusion</p> <p>The test- retest of IPAQ E- module resulted in moderate to almost perfect agreement for most of the items with few meaningful differences by gender. Environmental items of physical activity in an African population exhibited reliability similar to that in other environments. These results suggest that IPAQ E- module may be a useful measure for assessing environmental correlates of physical activity among population in Africa.</p

Physicians and AIDS Care: Does Knowledge Influence Their Attitude and Comfort in Rendering Care?

Adequate knowledge, positive attitude, and feeling of comfort are important factors in providing compassionate care to patients. The purpose of this study was to assess physicians\u2019 knowledge, attitude and global comfort in caring for patients with AIDS (PWA), to determine the sociodemographic variables that could influence physicians\u2019 attitude and global comfort, and to identify any relationship between their knowledge, attitude and comfort. Consultants and residents (N=211) in two Nigerian teaching hospitals were surveyed using a two-part questionnaire. Part I elicited sociodemographic and previous AIDS encounter information, and Part II assessed knowledge, attitude and global comfort with AIDS patients care. Nigerian physicians showed satisfactory knowledge, but they harbored negative attitude and low level of comfort in caring for PWA. Previous AIDS care experience, age and being a consultant or a senior resident influenced attitude, while male gender and knowing someone with AIDS influenced global comfort. Knowledge is weakly but positively associated with attitude, while attitude is modestly associated with comfort. The study reinforced the need for an ongoing education focused on experiential learning, and professional socialization in order to influence physicians\u2019 attitude and enhance their feeling of comfort when caring for PWA

Evaluation of the neighborhood environment walkability scale in Nigeria

Background: The development of reliable and culturally sensitive measures of attributes of the built and social environment is necessary for accurate analysis of environmental correlates of physical activity in low-income countries, that can inform international evidence-based policies and interventions in the worldwide prevention of physical inactivity epidemics. This study systematically adapted the Neighborhood Environment Walkability Scale (NEWS) for Nigeria and evaluated aspects of reliability and validity of the adapted version among Nigerian adults. Methods: The adaptation of the NEWS was conducted by African and international experts, and final items were selected for NEWS-Nigeria after a cross-validation of the confirmatory factor analysis structure of the original NEWS. Participants (N = 386; female = 47.2%) from two cities in Nigeria completed the adapted NEWS surveys regarding perceived residential density, land use mix - diversity, land use mix - access, street connectivity, infrastructure and safety for walking and cycling, aesthetics, traffic safety, and safety from crime. Self-reported activity for leisure, walking for different purposes, and overall physical activity were assessed with the validated International Physical Activity Questionnaire (long version). Results: The adapted NEWS subscales had moderate to high test-retest reliability (ICC range 0.59 -0.91). Construct validity was good, with residents of high-walkable neighborhoods reporting significantly higher residential density, more land use mix diversity, higher street connectivity, more traffic safety and more safety from crime, but lower infrastructure and safety for walking/cycling and aesthetics than residents of low-walkable neighborhoods. Concurrent validity correlations were low to moderate (r = 0.10 -0.31) with residential density, land use mix diversity, and traffic safety significantly associated with most physical activity outcomes. Conclusions: The NEWS-Nigeria demonstrated acceptable measurement properties among Nigerian adults and may be useful for evaluation of the built environment in Nigeria. Further adaptation and evaluation in other African countries is needed to create a version that could be used throughout the African region

Nurses

This study arose from the necessity to improve professional interaction and communication that can facilitate group process and team building for the benefit of the patients and clients. As different team members often have different perception of other professional

Perception of built environmental factors and physical activity among adolescents in Nigeria

Background: Understanding environmental factors related to adolescents' physical activity can inform intervention for obesity control and prevention, but virtually no study has been conducted in the African region, where adolescents' physical inactivity and chronic diseases rates are rising. This study assessed associations between perceived built environmental variables and adolescents' physical activity (active transportation to school and leisure-time moderate-to-vigorous physical activity), and the moderating effects of neighborhood-level income on association between environmental variables and physical activity among Nigerian boys and girls. Methods: Participants were 1006 adolescents (12-19 years, 50.4% girls) randomly selected from 11 secondary schools in Maiduguri city, Nigeria. Physical activity and perceptions of environmental characteristics were assessed by validated self-report questionnaires. Separate gender-based, hierarchical multiple moderated linear regression analyses were used to examine the direct associations between the environmental perceptions and physical activity variables (active transportation and leisure-time MVPA; dependent variables), as well as the moderating effects of neighborhood-level income. Results: Only in boys were direct associations and interaction effect of neighborhood-level income found. Access to destinations was positively associated with active transportation to school (beta = 0.18; CI = 0.67, 2.24); while residential density (beta = 0.10; CI = 0.01, 1.74) and availability/quality of infrastructures (beta = 0.14; CI = 0.49, 2.68) were positively associated with leisure-time MVPA. Also, neighborhood-level income moderated the association between perceived safety and leisure-time MVPA, with more perceived safety related to less MVPA (beta = -0.16; CI = -0.01, -0.70) in boys living in high SES neighborhood but marginally related to more MVPA (beta = 0.11; CI = -0.04, 2.88, p = 0.06) in boys living in low SES neighborhood. Conclusions: Few environmental attributes were associated with adolescents' physical activity in Nigeria. Future studies are needed to determine the multidimensional correlates of physical activity that may be relevant for both adolescents' boys and girls in Nigeria

Environmental factors associated with overweight among adults in Nigeria

Background: Understanding environmental factors related to obesity can inform interventions for the world wide obesity epidemic, yet no study has been conducted in this context in Africa. This study examined associations between neighbourhood environment variables and overweight in Nigerian adults. Methods: A total of 1818 randomly selected residents (age: 20-65 years, 40% female, 31% overweight and 61.2% response) living in high and low socioeconomic (SES) neighbourhoods in Metropolitan Maiduguri, Nigeria, participated in a cross-sectional study. Anthropometric measurements of height and weight and an interview-assisted self-reported measure of 16 items of perceived neighborhood environments were conducted. The primary outcome was overweight (body mass index [BMI] > or = 25 kg/m(2)) vs. normal weight (BMI = 18.5-24.9 kg/m(2)). Results: After adjustment for sociodemographic variables, overweight was associated with distant access to commercial facilities (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.02-2.18), poor neighbourhood aesthetics (OR, 1.58; 95% CI, 1.16-2.09), perceiving garbage and offensive odours in the neighbourhood (OR, 1.41; 95% CI, 1.05-1.89) and feeling unsafe from crime at night (OR, 1.47; 95% CI, 1.13-1.91) and unsafe from traffic (OR, 1.56; 95% CI, 1.17-2.07) in the total sample. Significant interactions regarding overweight were found between gender and four environmental variables, with low residential density (OR, 1.39; 95% CI, 1.02-1.93) and poorly maintained pedestrian pathways (OR, 1.89; 95% CI, 1.13-3.17) associated with overweight in men only, and absence of beautiful things (OR, 2.23; 95% CI, 1.42-3.50) and high traffic making it unsafe to walk (OR, 2.39; 95% CI, 1.49-3.83) associated with overweight in women only. There were few significant interactions between environmental factors and neighborhood SES regarding overweight. Conclusion: Neighbourhood environment factors were associated with being overweight among Nigerian adults. These findings support previous reports in international literature, but should be replicated in other African studies before any firm conclusions can be drawn

Readability, stability, and internal consistency of a new psychometric inventory on evidence-based practice in physiotherapy

Evidence-based practice (EBP) has, in the last decade, gained global prominence in health care professions because it provides the framework for lifelong and self-directed learning. These traits are crucial for the continued provision of quality health care. This study sets out to develop a culturally appropriate instrument to measure physiotherapists' knowledge, beliefs, attitudes, and behaviors relative to the use of EBP and establish the instruments' psychometric properties. A 53-item EBP inventory that consisted of seven parts sociodemographic, EBP competence and behaviors, perceived knowledge of EBP, perceived skills and resources, attitudes about EBP, and barriers related to the use of EBP was created. Theinstrument was administered to 25 physiotherapists within a two-week interval on two occasions. The Flesch-Kincaid Reading Ease and Flesch-Kincaid scores for the instrument were 49.5 and 8.3, respectively. Its Cronbach alpha range from "fair" (0.333, p<.001) to "almost perfect" (0.837, p<.001). The test-retest (stability) scores for the instrument parts were significantly (?2 = 4.738, p<.038) different for only one (competence on EBP) of the seven factors. The overall findings revealed the instrument is relatively easy to comprehend, highly stable, and internally consistent. The availability of this instrument will promote further studies of EBP in physiotherapy