This disease is “not for hospital”: myths and misconceptions about cancers in Northern Nigeria

Cancers are one of the major chronic diseases in Nigeria, with over 100,000 new cases and 70,000 cancer deaths recorded annually. Notwithstanding the public health significance of cancers in Nigeria, there is a dearth of evidence relating to cancers in the country, with most of the few available studies conducted in the Southern regions. This paper aimed to highlight some longstanding myths and misconceptions about cancers in the Northern Nigerian region. We consulted key stakeholders including individuals, local leaders, traditional medicine practitioners, and healthcare professionals. The most common myths and misconceptions about cancers in Northern Nigeria include the following: people get cancers from mystical sources originating in the forests or bush; western medication or hospital treatment worsens cancers; and, witchcraft can be used to transmit cancers to people. Understanding the traditional beliefs and local perceptions of non-communicable diseases is invaluable for informing sustainable and effective interventions. Thus, our paper will be useful for epidemiological, anthropological, and social research into effective preventive measures for cancers in Northern Nigeria and other regions with similar entrenched traditional beliefs about cancers

Application of disease mapping to a global public health issue in low- and middle-income countries : a case study of hypertension.

Background Hypertension is a global public health problem. It is the number one risk factor for mortality and the third leading cause of disability-adjusted life-years (DALYs) worldwide. The burden of the disease is more severe in low- and middle-income countries, where prevalence estimates are projected to increase by 30% over the next decade. This is not surprising owing to the on-going epidemiological transition taking place in these countries, where the interplay between social factors and disease is highly pertinent. However, evidence on the burden of hypertension and its determinants in low- and middle-income countries are limited. The overall aim of this research is to examine the prevalence and status of hypertension in low- and middle-income countries. The definition of hypertension used in this research is blood pressure measurement of ≥140 /90 mmHg (SBP/DBP), the use of antihypertensive medication, or self-reported physician diagnosis of hypertension. Objectives -To estimate the overall prevalence of hypertension in low- and middle-income countries. -To examine the socio-demographic determinants of hypertension in low- and middle-income settings. -To examine the geographic variation of hypertension prevalence in selected low-and middle-income countries. -To interpret the findings and discuss their implications for practice/policy and future research. Methods A systematic review and meta-analysis was conducted to provide overall and regional estimates of hypertension prevalence across low- and middle-income countries, and to examine patterns of the disease across different socio-demographic characteristics in these settings. Studies reporting hypertension prevalence in low- and middle-income countries were sought from electronic databases and grey literature. The data from these studies were analyzed using random-effects meta-analyses and sub-group analyses. Secondary data analyses of DHS datasets were also conducted to estimate hypertension prevalence and examine its geographic variation in selected low- and middle-income countries with hypertension data, while accounting for a number socio-demographic characteristics. The secondary data analyses entailed logistic regression and Bayesian geo-additive analyses. Odds ratios with 95% confidence intervals were reported for the logistic regression analyses, whereas posterior odds ratios with 95% credible intervals were reported for the Bayesian geo-additive analyses. Results The systematic review included 242 studies, comprising 1,494,609 adults from 45 countries. The overall prevalence of hypertension was 32.3% (95% confidence interval [CI] 29.4–35.3) with the Latin America and Caribbean region reporting the highest prevalence (39.1%, 95% CI 33.1–45.2). Prevalence was also highest in upper-middle income countries (37.8%, 95% CI 35.0–40.6) and lowest in low-income countries (23.1%, 95% CI 20.1–26.2). Prevalence among adults ≥65 years was substantially higher than adults <65 years; however, there was no significant sex-difference overall (31.9% vs 30.8%, p=0.6). Prevalence was generally higher among the non-educated compared to educated people (49.0% vs. 24.9%, p<0.05), among overweight/obese persons compared to normal weight (46.4% vs. 26.3%, p<0.05), and among urban settlers compared to rural (32.7% vs 25.2%, p=0.0005). Meta-regression showed that combined overweight/obesity (p<0.05) and being uneducated (p<0.05) significantly accounted for between-study heterogeneity in hypertension rates The secondary analysis comprised data on 93,247 respondents in 10 selected countries (Albania, Armenia, Azerbaijan, Ukraine, Uzbekistan, Egypt, Morocco, Lesotho, Senegal and Maldives). The prevalence of hypertension was lowest in Morocco (5.4%) and highest in Albania (22.7%). Age was the most consistent predictor of hypertension. Being employed was protective in the Eastern European countries (Albania, Armenia, Azerbaijan, Ukraine and Uzbekistan) (p<0.05 for each) and in African countries such as Egypt and Senegal (p<0.05 for each). Education was protective in Egypt, Senegal and Maldives (p<0.05 for each), but may be a strong determinant in Lesotho given the extremely high literacy rates in the country. Examining the geographic variation of hypertension revealed that Tirana and Elbasan districts had the highest burden of hypertension compared to other districts in Albania; Sharkia and Kalyoubia districts had the highest burden of hypertension compared to other districts in Egypt; while Quthing and Maseru districts had the highest burden of hypertension in Lesotho. Conclusion Overall, the findings provide contemporary and up-to-date estimates that reflect the significant burden of hypertension in low- and middle-income countries and evidence that hypertension remains a major public health issue in these settings. The findings also suggest that addressing the wider social determinants of hypertension, such as illiteracy and unemployment, may reduce overall prevalence of the disease in low- and middle-income countries

A Cross-sectional Study of Self-Perceived Educational Needs of Emergency Nurses in Two Tertiary Hospitals in Nairobi, Kenya

Background: Many low- and middle-income countries lack resources for well-functioning emergency care systems. Emer- gency nurses interact with injured and critically ill patients as the first contact in many health care settings. However, insuffi- cient training limits nurses from providing ideal emergency care. The purpose of this research was to highlight educational needs specific to nurses working in 2 emergency departments in Nairobi, Kenya. Methods: A descriptive cross-sectional study involving emer- gency units of 2 of the largest referral and teaching hospitals (Aga Khan University Hospital, Nairobi, and Kenyatta National Hospital) in Nairobi, Kenya, was conducted. Data were collected by using an adapted structured, self-administered questionnaire. The data were analyzed using descriptive statis- tics. The skills and competencies of the participants were assessed. In addition, the educational gaps and needs of the participants around emergency care such as trauma, cardiovas- cular diseases, and respiratory and neurological illnesses were described. Results were presented in frequencies and percentages. Results: The questionnaire response rate was 63.6% (n ¼ 84). Most of the respondents held associate degrees in nursing (72.6%), whereas 19% had a bachelor’s degree in nursing. Most respondents (84.5%) perceived themselves as being highly competent in basic skills such as performing cardiopulmonary resuscitation and assessment of body systems. Less than half of the respondents (48.8%) perceived themselves as being highly competent in intermediate skills such as assisting with endotracheal intubation. In advanced competencies, such as analyzing electrocardiograms and administering thrombolytic medications, only 16.7% perceived themselves as highly competent. Conclusion: The results of this study suggest there is a knowledge gap and educational needs among emergency nurses in Nairobi, Kenya. It identified injuries/trauma; cardio- vascular, respiratory, and neurological disease; and other emer- gencies as topics of focus areas with a high need. To address these knowledge and skills needs, a future specialty training in emergency nursing is recommended and this could be achieved through continuing professional development and short courses or postgraduate-level training

Health workers’ documentation process as a prerequisite to the integration of patient care at a Regional Referral Hospital in Uganda

Background: Integrated patient care is necessary for better care outcomes. Documentation enhances the integration of care; however, in the Ugandan setting, documentation of care is poor (e.g., omissions and incomplete records) and integration of patient care is not visible. This study presents a review of patient health records that was undertaken to understand documentation of care at a regional referral hospital in Eastern Uganda. This information will help in developing a documentation model to facilitate the integration of patient care in Uganda. Methodology: This retrospective review involved 513 patient health records from the medical-surgical, pediatric, and obstetric/gynecological departments of Jinja Regional Referral Hospital. Data were collected using checklists. Stratified sampling was used to capture variations in ward unit records and identify a fair representation of each department. Data were analyzed with descriptive and inferential statistics. All analyses were performed with SPSS version 22. Results: On average, the study hospital attended to 1000 patients per day and discharged 100 patients per ward unit per month. Our record review showed that documentation by both nurses and doctors was incomplete, and care was fragmented. However, doctors documented care more often than nurses, although the integration of patient care was not evident in doctors’ documentation. Conclusion: To establish integrated patient care, documentation must meet standards set by relevant professional bodies. The findings of this study will inform the development of a feasible documentation model to facilitate the integration of patient care in Uganda

Professional image of nursing and midwifery in East Africa: an exploratory analysis

Background: Evidence suggests that there is a negative image of nursing and midwifery that does not promote these professions as attractive career options. Furthermore, there is a paucity of studies documenting how nursing and midwifery is perceived in East Africa and where such studies exist they are country-specific. The aim of this study was to explore views regarding the image of nursing and midwifery among nurses and midwives in three East African countries, Kenya, Tanzania and Uganda. Methods: An exploratory descriptive cross-sectional study administered online using Survey Monkey Questionnaires assessed the views and perceptions of nurses and midwives regarding the image of nursing and midwifery professions. Descriptive statistics and Pearson’s Chi square tests were used to analyse the data. The semi-structured questions were analysed using content analysis. Results: A total of 551 participants took part in the study. The majority were females (61.8%), registered nurses/ midwives (45.8%), and aged 30–39 years (34.2%). Most of the respondents were from Kenya (39.7%) and Uganda (32.9%). About two-thirds of the nurses and midwives in this study perceived nursing/midwifery as both trusted and respected professions and expressed having a level of control over how their image was portrayed. Conversely, the nurses and midwives were conscious that the public had mixed responses about the nursing/midwifery professions specifically, some members of the public described nurses/midwives as professionals, knowledgeable and caring, others perceived nurses/midwives to be rude, cruel, unkind, lazy, unkempt, and maids. Conclusion: This study offers an interesting insight about the image of nursing/midwifery in East Africa. Findings from this study will inform policy makers and educators about key concepts that affect the image of nursing and midwifery in East Africa. The findings will be used to design marketing materials to help improve the image of nursing and midwifery in the region and other African countrie

Sociodemographic factors associated with mothers’ experiences of psychosocial care and communication by midwives during childbirth in Nairobi, Kenya

Purpose: To clarify sociodemographic and socioeconomic factors associated with mothers’ experiences of psychosocial care and communication by midwives during childbirth in Nairobi, Kenya. Design: A descriptive cross-sectional study conducted in a government national referral hospital. Respondents were 109 systematically sampled mothers who delivered in the study hospital. Mothers’ experiences of intrapartum care were assessed using three subscales from the Experience of Psychosocial Care and Communication during Childbirth Questionnaire (effective communication; emotional support; and respect, care and dignity). Simple and multivariable logistic regression analyses were used to assess associations between sociodemographic factors, socioeconomic factors and mothers’ experiences of intrapartum care. Findings: The majority of respondents were aged 20–24 years (45.9%), married (71.6%), had primary school education (48.6%) and were self-employed (45%). The majority reported positive experiences of communication, respect, dignity and emotional support from their midwives. Being an older mother was significantly associated with a positive experience of intrapartum care (adjusted odds ratio [AOR] 7.32; 95% Confidence Interval (CI): 1.17–45.9). The odds of having a positive intrapartum care experience was significantly lower among women with parity of four or more (AOR 0.09; 95% CI: 0.01–0.56) and tertiary education (AOR 0.11; 95% CI: 0.01–0.91). Conclusion: Attention to the use of respectful language and adherence to clear communication must be an integral part of quality improvement for midwifery care in Kenya

Medical device-related pressure ulcers: a systematic review and meta-analysis

Objective To review observational studies reporting medical device-related pressure injuries and to identify the medical devices commonly associated with pressure injuries. Design A systematic review of primary research was undertaken, according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Data sources A comprehensive electronic literature search of AMED, CINAHL, MEDLINE, PsycINFO, Web of Science, British Nursing Database and Google Scholar was conducted from inception to 31st December 2018. Studies that reported the prevalence or incidence of medical device-related pressure injuries and published in English language were included in the review. Review methods The eligibility of studies was evaluated independently by three of the four authors and audited by an independent researcher. The titles and abstracts of all studies were screened to identify studies that met the inclusion criteria. Full-text articles of the remaining studies were obtained and screened against the inclusion criteria. Risk of bias was assessed using the Newcastle-Ottawa scale. Meta-analysis was conducted using the ‘metaprop’ routine, with estimates of medical device-related pressure injuries from the included studies pooled using DerSimonian-Laird random-effects model. Meta-regression analysis was also conducted to examine between-study heterogeneity. Results Twenty-nine studies (17 cross-sectional studies; 12 cohort studies) comprising data on 126,150 patients were eligible for inclusion in this review. The mean ages for patients were approximately 36.2 years (adults) and 5.9 years (children). The estimated pooled incidence and prevalence of medical device-related pressure injuries were 12% (95% CI 8 – 18) and 10% (95% CI 6 – 16) respectively. These results should be interpreted with caution given the high levels of heterogeneity observed between included studies. The commonly identified medical devices associated with the risk of developing medical device-related pressure injuries include respiratory devices, cervical collars, tubing devices, splints, and intravenous catheters. Conclusions Medical device-related pressure injuries are among key indicators of patient safety and nursing quality in healthcare facilities. This systematic review and meta-analysis provide up-to-date estimates of the extent and nature of medical device-related pressure injuries, and the findings suggest that device-related pressure injuries are a public health issue of significance, especially as these injuries affect patients’ wellbeing and increase the cost of care for both patients and providers. Further research is required to inform strategies for increasing the reporting and risk assessment of medical device-related pressure injuries

Capacity building among nursing and midwifery professional associations in East Africa

Background: Despite improvements in educational opportunities, policy changes, and pay raises in the nursing and midwifery professions in East Africa, poor working conditions, few professional development opportunities, and a general lack of respect for these professions predominate. These issues contribute to a low quality of care among a population with a high burden of communicable diseases. Health professional associations may help to address these challenges by providing a voice for nurses and midwives. Objective: This study evaluated the impact of a 5-year programme focused on strengthening nurses’ and midwives’ professional associations in East Africa. Methods: This study used a mixed methods design. Quantitative, cross-sectional descriptive data were captured via surveys (n = 1,266) distributed to association members. In-depth interviews (n = 65) were used to obtain qualitative data and complement the survey responses. Quantitative and qualitative data collection occurred concurrently. The results were compared to assess the impact of the programme across Uganda, Kenya, and Tanzania. Results: The programme successfully built capacity in four of five organisational capacity areas: resource mobilisation, financial management, strategy, and monitoring and evaluation. Marketing and communications, the fifth targeted area, did not show improvement. Capacity in both research and service delivery was also improved, despite the programme not providing training in these areas. In addition, collaboration among associations and their members was improved. Conclusion: These results support existing evidence on the impact of capacity building among professional nursing associations and coincide with the World Health Organization’s objectives for nursing. Future capacity building programmes should consider replicating the successful activities from this programme and investigate ways to reach more rural branches and provide tailored content. This study contributes to a small but growing body of knowl- edge that supports capacity building among the African health workforce

Trends in and predictors of pregnancy termination among 15–24 year-old women in Nigeria: a multi-level analysis of demographic and health surveys 2003–2018

Background: Three-quarters of pregnancy terminations in Africa are carried out in unsafe conditions. Unsafe abortion is the leading cause of maternal mortality among 15–24 year-old women in Sub-Saharan Africa. Greater understanding of the wider determinants of pregnancy termination in 15–24 year-olds could inform the design and development of interventions to mitigate the harm. Previous research has described the trends in and factors associated with termination of pregnancy for women of reproductive age in Nigeria. However, the wider determinants of pregnancy termination have not been ascertained, and data for all women have been aggregated which may obscure differences by age groups. Therefore, we examined the trends in and individual and contextual-level predictors of pregnancy termination among 15–24 year-old women in Nigeria. Methods: We analysed data from the 2003, 2008, 2013 and 2018 Nigerian Demographic and Health Surveys (NDHS) comprising 45,793 women aged 15–24 years. Trends in pregnancy termination across the four survey datasets were examined using bivariate analysis. Individual and contextual predictors of pregnancy termination were analysed using a three-level binary logistic regression analysis and are reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results: Trends in pregnancy termination declined from 5.8% in 2003 to 4.2% in 2013 then reversed to 4.9% in 2018. The declining trend was greater for 15–24 year-old women with higher socioeconomic status. Around 17% of the total variation in pregnancy termination was attributable to community factors, and 7% to state-level factors. Of all contextual variables considered, only contraceptive prevalence (proxy for reproductive health service access by young women) at community level was significant. Living in communities with higher contraceptive prevalence increased odds of termination compared with communities with lower contraceptive prevalence (aOR = 4.2; 95% CI 2.7–6.6). At the individual-level, sexual activity before age 15 increased odds of termination (aOR = 2.3; 95% CI 1.9–2.8) compared with women who initiated sexual activity at age 18 years or older, and married women had increased odds compared with never married women (aOR = 3.0; 95% CI 2.5–3.7). Conclusion: Our findings highlight the importance of disaggregating data for women across the reproductive Life course, and indicates where tailored interventions could be targeted to address factors associated with pregnancy termination among young women in Nigeria