Review of article palliative care in Nigeria: Challenges and prospects

Background: Health workers seek to cure ailments with surgery, medication and occasionally radiotherapy .In resource constrained settings such as that prevalent in Nigeria however, patients often present with late stage diseases where it is not practical to expect cures . Palliative care seeks to ease the suffering of the many patients who cannot be cured against the back drop of late presentation of patients with life limiting illnesses. It is a relatively new concept in medical practice in Nigeria and has yet to be fully integrated into patient care while encountering limited successes and impediments by health practitioners ,policy makers and occasionally clients.Method: This is a review article on of various policies and publications concerning Palliative care in Nigeria using different search engines such as Pubmed and Google.Conclusion: Palliative care implementation in Nigeria is still a work in progress with limited availability in health facilities in the country.Key words: Palliative care, Pain relief, Oral morphin

Prevalence of postdural puncture headache among caesarean section patients in North Central Nigeria

Spinal anaesthesia is now a popular choice for Caesarean sections in Africa but one of the draw-back is the development of post-dural puncture headache (PDPH) and it could be quite distressing to a mother. Identifying risk factors and reducing the prevalence is pertinent. This study sought to determine the prevalence of PDPH among patients who underwent Caesarean sections in a tertiary hospital in Jos, Plateau State, Nigeria and some of its possible associated factors. Method: It was a prospective study of all Caesarean sections done under spinal anaesthesia between November 2016 and June 2017. Spinal anaesthesia was performed on 236 parturients using Quincke-type needles sizes 23-26G. In the postoperative period, all the patients were followed-up to determine the incidence, onset, and severity of post-dural puncture headache. Epi-info version 7 was used for data analysis. Results: The prevalence of PDPH was 22.03%. Most of the parturients who developed PDPH in our study were of mild to moderate intensity using the numeric rating scale. Twenty six (11%) had mild, while 11 (4.7%) had moderate intensity of headache and which was resolved with treatment. Conclusion: The prevalence of PDPH is high in the obstetric population especially with the use of traumatic Quincke-type needles. Deliberate efforts must be made to reduce its occurrence by acquiring of small calibre pencil-point needles and training staff on how to use it

Comorbidities among infertile women at NKST hospital Mkar-Gboko, North-Central Nigeria

Background:  Infertility, a common, non-fatal ailment, is sometimes associated with substantial comorbidity that can add adverse outcomes during treatment or pregnancy and increase costs of care. This study aims to assess the magnitude and pattern of comorbidities in infertile Nigerian women.Method: This descriptive retrospective study was undertaken at NKST Hospital Mkar-Gboko, Nigeria, from 1st January 2005 to 31st July 2013. Clinic records of patients who attended the gynaecological outreach clinic were retrieved and analyzed using descriptive statistics and test of associations with Microsoft Excel 2013.  Jos University Teaching Hospital gave ethical clearance.Results: 1,926 women seen during the study period, 1030 (53.5%) presented for infertility care. 941 (91.4%) women had complete records, among them, 476 (50.5%) met the inclusion criteria, and their records were analyzed. The mean age of the women was 32.6±6.0 years with a range of 20 to 53 years, see Table1. There were 52 comorbid conditions among the 476 women. The comorbidities included uterine myoma, previous appendectomy/pelvic surgeries, genital tract infections/retroviral disease, hypertension, obesity and diabetes, among others, see Table 4. Table 2 and 3 shows there is a significant statistical association between comorbidity type, age, parity, duration of infertility and symptoms complex between infertile women and comorbidities (p<0.05).Conclusion: Comorbidities that can influence treatment and pregnancy outcomes are common among infertile women in central Nigeria. This finding strongly supports the routine assessment of women for comorbidities during infertility care for appropriate multidisciplinary management and counselling

Bibliometric analysis of authorship patterns in publications from a research group at the London School of Hygiene & Tropical Medicine, 2016-2020

BACKGROUND: Authors from low and middle-income country (LMIC) institutions are under-represented in publications of research based in LMICs. This case study of publications from authors within the Medical Research Council International Statistics and Epidemiology Group (MRC-ISEG), a global health research group affiliated to the London School of Hygiene & Tropical Medicine in the UK, aims to describe patterns in authorship and factors associated with under-representation. METHODS: Papers were included if they were published between January 2016 and December 2020 inclusive, included an author from the MRC-ISEG and described work conducted in a LMIC. Authors' affiliations were classified using World Bank country income classifications into LMIC affiliations only, high-income country (HIC) affiliations only and mixed LMIC/HIC affiliations. Multinomial logistic regression analysis was used to assess associations of author affiliation category with authorship position, and whether patterns varied by journal impact factor quartile and multiple versus single-country studies. RESULTS: A total of 882 papers, including 10 570 authors describing research conducted in 61 LMICs, were included. Compared with authors of HIC-only affiliation, those with LMIC-only affiliation were less likely to be in first authorship position (relative risk ratio (RRR)=0.51, 95% CI 0.44 to 0.60) and mixed HIC/LMIC affiliation authors were more likely (RRR=2.80, 95% CI 2.35 to 3.34). Compared with authors of HIC-only affiliation, those with LMIC-only affiliation were less likely to be in last authorship position (RRR=0.20, 95% CI 0.16 to 0.24) and those with mixed HIC/LMIC affiliations were more likely (RRR=1.95, 95% CI 1.65 to 2.30). The proportion of senior authors with LMIC-only affiliation was lowest for the highest impact journals, and in multicountry versus single-country studies. CONCLUSION: Alongside increasing research capacity within LMICs, HIC institutions should ensure that LMIC-affiliated researchers are properly represented in global research. Academics working in global health should be judged on their involvement in representative collaborative research rather than individual achievements in authorship position

Induction of labour at Jos University teaching, hospital, Jos, Nigeria: a four year review

Background: Induction of labour (IOL) is a common procedure that remains a relevant Obstetric procedure. The maternal and perinatal outcomes are paramount hence the need to review the intervention in order to implement needed change.Objectives: To determine incidence, indications, outcome and complications of induction of labour at the Jos University Teaching Hospital (JUTH), Jos, Nigeria.Methods: This was a retrospective study reviewing 584 women who had IOL in JUTH from January 2004 to December 2007. Parameters selected for review include parity, gestation age, outcome and cervical state prior to IOL.Results: Four hundred and eighty women had vaginal deliveries (82.2%). There were fifty two induced on account of antepartum Intra Uterine Foetal Deaths (IUFD), while 1.5% of the deliveries ended up as still births, 10.5% had birth asphyxia and neonatology review and care. Thirty two patients had various complications after IOL. There were no maternal mortalities.Conclusion: Parity and presence of IUFD were found to influence the outcome of IOL

Knowledge, attitude and practice of maternity unit staff in Jos Metropolis to universal precautions against HIV

Background: Health care workers in maternity units are exposed to potentially infectious body fluids in the course of their duties. The study assessed the knowledge, attitude and practice of maternity unit staff in Jos Metropolis regarding Universal Precautions (UP) against the background of the high HIV seroprevalence in Plateau state, Nigeria.Methods: A cross sectional descriptive study carried out among maternity unit staff in Jos, Nigeria. A pretested, structured, anonymous questionnaire on knowledge, attitude and practice on universal precautions concerning HIV was administered to a sample of 230.Results: A total of 202 questionnaires were completed and returned giving a response rate was 87.8%, 68.5% of the respondents were female and 31.5% male; 63 of the respondents were physicians while 139 were non physicians. 52 (82.5%) physicians and 113 (81.3%) non physician cadre staff correctly identified UP in the context of labour ward practice to apply to blood, vaginal secretions and liquor. 54 (85.7%) of the physicians and 87 (62.6%) identified that UP involved use of barrier methods. Being a physician conferred knowledge of correct use of barrier methods..Conclusion: A majority of the respondents demonstrated correct knowledge of practice of UP . There was no significant difference in knowledge between physician and non physician cadre of labour ward staff with regard to correctly identifying the fluids that UPs apply to. Physician cadre of labour ward staff in Jos metropolis was associated with the correct identification of barrier methods that UPs apply to.Keywords HIV, Universal precautions, Maternity unit staff, Jos

The impact of the COVID-19 pandemic on routine HIV care and cervical cancer screening in North-Central Nigeria

Abstract Introduction Cervical cancer is the fourth most diagnosed cancer among women globally, with much of the burden being carried by women in limited-resource settings often worsened by the high prevalence of HIV. Furthermore, the COVID-19 pandemic disrupted organized screening efforts and HIV management regimens worldwide, and the impact of these disruptions have not been examined in these settings. The purpose of this paper is to describe whether uptake of cervical cancer screening and HIV management changed before, during, and since the COVID-19 pandemic in North-Central Nigeria. Methods Longitudinal healthcare administration data for women who obtained care between January 2018 and December 2021 were abstracted from the AIDS Prevention Initiative Nigeria (APIN) clinic at Jos University Teaching Hospital. Patient demographics, pap smear outcomes, and HIV management indicators such as viral load and treatment regimen were abstracted and assessed using descriptive and regression analyses. All analyses were conducted comparing two years prior to the COVID-19 pandemic, the four quarters in 2020, and the year following COVID-19 restrictions. Results We included 2304 women in the study, most of whom were between 44 and 47 years of age, were married, and had completed secondary education. About 85% of women were treated with first line highly active retroviral therapy (HAART). Additionally, 84% of women screened using pap smear had normal results. The average age of women who sought care at APIN was significantly lower in Quarter 3, 2020 (p = 0.015) compared to the other periods examined in this study. Conversely, the average viral load for women who sought care during that period was significantly higher in adjusted models (p < 0.0001). Finally, we determined that the average viral load at each clinic visit was significantly associated with the period in which women sought care. Conclusions Overall, we found that COVID-19 pandemic mitigation efforts significantly influenced women’s ability to obtain cervical cancer screening and routine HIV management at APIN clinic. This study buttresses the challenges in accessing routine and preventive care during the COVID-19 pandemic, especially in low-resource settings. Further research is needed to determine how these disruptions to care may influence long-term health in this and similar at-risk populations