Experiences of mistreatment among medical students in a University in south west Nigeria

Objective: This study was conducted to assess the experiences of mistreatment and harassment among final-year clinical students in a Nigerian medical school.Materials and Methods: A self-administered questionnaire was used to obtain information on the various forms of mistreatment experienced by 269 students in the 2007 and 2008 graduating classes of a medical school in Nigeria.Results: Almost all the respondents (98.5%) had experienced one or more forms of mistreatment during their training. The commonest forms experienced by the students were being shouted at (92.6%), public humiliation or belittlement (87.4%), negative or disparaging remarks about their academic performance (71.4%), being assigned tasks as punishment (67.7%), and someone else taking credit for work done by the student (49.4%). Religious or age discrimination was reported by 34.2%, sexual harassment and other forms of gender-based mistreatment by 33.8%, and threats of harm by 26.4%. These incidents were mainly perpetrated by physicians and occurred mostly during surgical rotations. The effects included strained relationships with the perpetrators, reduced self-confidence and depression.Conclusion: Most medical students experienced verbal forms of mistreatment and abuse during their training. Appropriate strategies for the prevention and reduction of medical student mistreatment should be developed

Factors Influencing the Choice of Health Care Providing Facility Among Workers in a Local Government Secretariat in South Western Nigeria

Background: There is increasing interest in the choice of healthcare providing facility in Nigeria.Objectives: This study aimed to assess the factors influencing choiceand satisfaction with health service providers among local government staff.Methods: A cross sectional survey of all 312 workers in a Local Government Secretariat in South West Nigeria was done. Chi Square and logistic regression analysis was done.Results: The mean age was 38.6 ± 7.5 years, 55% were females and71.7% had tertiary education. The median monthly family income of the respondents was N 28, 000 (N3,000 – N500,000), with 24.4% earning a monthly income of N21, 000 to N30, 000. Many (72.3%) utilized public health facilities attributing the choice to the low cost of services.  Respondents who are satisfied with their usual care providing facilities are 12.2 times more likely to have used public facilities than private facilities (95%, CI 3.431 – 43.114). Respondents who described the quality with ease of getting care/short waiting times as being good are 3.9 times more likely to have private facilities as their chosen health care providing facility (95%, CI 1.755 – 8.742). Cost/payment for service is 2.9 times more likely to predict the use of public health facility as the usual health care provider.Conclusion: Private facilities though costlier do not appear to be providing better services than public facilities. To increase access to health care the cost of services and the waiting time are important factors to address.Keywords: Service, Quality, Cost, Choice, Satisfactio

Falls and outcomes amongst old people in rural dwellings

Background: Falls are the leading cause of injury deaths among people 65 years and older. This study gives an insight into the prevalence of falls among older people and how they occur in a rural setting in Nigeria.Methods: A community based survey of 210 consenting old people aged 65 years and above selected using a multi-stage sampling technique was done. Study instrument was a semi-structured interviewer administered questionnaire and visual acuity was tested using Snellens chart.Results: Incidence of falls was 21.4%. Of those who had falls, 86.7% were walking while 11.1% were either sitting or running when it occurred. The nature of the fall was tripping in 44.4%, slipping in 35.6% and hitting an object in 17.8% of cases. Consequences of falls included pain 48.9%, bruises 22.2%, lacerations 13.3% and fractures 11.1%. Females had more falls than males; 23.8% vs 19.0%, p = 0.40. Major injuries resulting fromfalls also occurred more frequently amongst females than males; 30.7% vs. 15.0%, p = 0.3. History of diabetes and alcohol use increased the odds of falling (OR 4.1, 95% CI 1.0 – 16.0; OR 2.2, 95% CI 1.0 – 4.6 respectively). Being in a monogamous marriage and having normal sight were protective of having falls (OR 0.4, 95% CI 0.2 – 0.9; OR 0.4, 95% CI 0.2 – 0.9 respectively). Conclusion: Falls often occur from tripping and slipping while females are more likely to have major injuries. Risk factors for falls were alcohol use and diabetes while having normal sight andbeing monogamous were protective. Prevention should aim at a life course approach to addressing these intrinsic and extrinsic factors

Measuring oxygen access: lessons from health facility assessments in Lagos, Nigeria

The COVID-19 pandemic has highlighted global oxygen system deficiencies and revealed gaps in how we understand and measure ‘oxygen access’. We present a case study on oxygen access from 58 health facilities in Lagos state, Nigeria. We found large differences in oxygen access between facilities (primary vs secondary, government vs private) and describe three key domains to consider when measuring oxygen access: availability, cost, use. Of 58 facilities surveyed, 8 (14%) of facilities had a functional pulse oximeter. Oximeters (N=27) were typically located in outpatient clinics (12/27, 44%), paediatric ward (6/27, 22%) or operating theatre (4/27, 15%). 34/58 (59%) facilities had a functional source of oxygen available on the day of inspection, of which 31 (91%) facilities had it available in a single ward area, typically the operating theatre or maternity ward. Oxygen services were free to patients at primary health centres, when available, but expensive in hospitals and private facilities, with the median cost for 2 days oxygen 13 000 (US$36) and 27 500 (US$77) Naira, respectively. We obtained limited data on the cost of oxygen services to facilities. Pulse oximetry use was low in secondary care facilities (32%, 21/65 patients had SpO2 documented) and negligible in private facilities (2%, 3/177) and primary health centres (<1%, 2/608). We were unable to determine the proportion of hypoxaemic patients who received oxygen therapy with available data. However, triangulation of existing data suggested that no facilities were equipped to meet minimum oxygen demands. We highlight the importance of a multifaceted approach to measuring oxygen access that assesses access at the point-of-care and ideally at the patient-level. We propose standard metrics to report oxygen access and describe how these can be integrated into routine health information systems and existing health facility assessment tools

Chapter 4. Extract of Africa: Towards the Equitable and Ecologically Sound Governance of Mining and Drilling

Background: Economists and political scientists have long recognised four kinds of goods: private, public, common-pool and club, the assumption being that category membership is determined by the physical properties of the goods themselves. But in the theory of plural rationality—the approach taken in this chapter—where specific goods end up is, to the extent that that is not determined by their physical properties, the outcome of a never-ending struggle between four kinds of social solidarity: individualism (which works towards privatisation), hierarchy (which favours the creation of public goods), egalitarianism (which is supported by common-pool goods) and fatalism (whose upholders enable club goods by the ease with which they can be excluded). Methodology: The study uses historical surveys and case-studies of different contexts where natural resource governance has upset harmonious relationship between different stakeholders. Application/Relevance to systems analysis: Our argument is that policy and governance, particularly in Africa, have allowed (indeed encouraged) individualism and hierarchy to dominate, thereby drowning out the other two institutional “voices”. The result, as we show by way of a continent-wide historical survey and three case-studies—REDD+ in the Democratic Republic of Congo, acid mine drainage in South Africa and oil extraction in Nigeria—has been “crap” governance (in contrast to good governance, which requires that all four voices are both heard and responded to by the others). Put another way, the “resource curse” is not the inevitable consequence of a country being heavily reliant on extractive industries; it stems from insufficient “clumsiness”: exemplified, as Kofi Annan has recently pointed out, by just two solidarities—multinational companies (individualism) and political leaders (hierarchy)—colluding to swindle the citizens out of their just rewards from their natural resources. Policy implications: Of policy implication, is the bringing-in of the two currently excluded voices, and we conclude by showing how, in relation to our case-studies, this can be achieved. Conclusion: Analyses of resource-related conflicts, especially in Africa, have often ignored the voices of the excluded social solidarities. Analysing this problem through a systems perspective will allow the incorporation of all voices as a way of constructing a more harmonious system in natural resource governance