Assessing Performance of Resident Doctors in Training in Northwestern Nigeria

Background: Residency training is a postgraduate medical education where graduate doctors are mentored toward becoming   independent specialists. In Nigeria currently, the Medical Residency Training Act (MRTA) 2017 guides residency training under the regulation of three postgraduate medical colleges: the National Postgraduate Medical College of Nigeria (NPMCN), West African College of Surgeons (WACS), and West African College of Physicians (WACP). For the respective colleges, resident doctors are expected to attempt Part One and Part Two fellowship examinations after completing their junior and senior residency training, respectively, within stipulated durations. Objectives: The aim of this study is to assess resident doctors’ performance in training and predictive factors. Methodology: Electronic  questionnaires was distributed to respondents through their contacts or emails. Data was collected within a period of one month, from July 10 to August 6, 2020. Data was analyzed using mean, standard deviation, simple tables as well as t‑test and Chi‑square test. The level of significance was set at 0.05 for decision purposes. Results: A total of 120 participants were involved in the study. The mean age of respondents was 38.0 ± 3.8 years, with a majority of 88 (83.3%) males and 107 (89.2%) married. On the first attempt, 48 (65.8%), 37 (60.6%), and 15 (57.7%) respondents were successful in NPMCN, WACS, and WACP Part One fellowship  examinations, respectively. There was no significant difference in the success in Part One between the three postgraduate medical  colleges. There was significant difference in the duration between the first attempt and success in Part One examinations for the three colleges, respectively (NPMCN – P = 0.001, WACS – P < 0.001, WACP – P = 0.036). Conclusion: There was a comparable success in Part One fellowship examination between the three postgraduate medical colleges, with over half of respondents recording success in their first attempt. However, there were significant delays between the first attempt and  success in Part One examination for the three postgraduate medical colleges. Keywords: Part One examination, performance, residency trainin

Assessing Research Engagement of Resident Doctors in Training in Northwestern Nigeria

Background: Residency training develops trainees to practice evidence-based medicine using knowledge acquired through researches. Resident doctors are not just expected to be consumers of good researches but are also expected to build their competencies in conducting researches in their fields of specialization. They are expected to engage in journal clubs as well as scientific paper presentations in local and international conferences under the mentorship and guidance of their trainers. In addition, trainers in residency training supervise the compulsory dissertation of senior residents under them. Objectives: We aimed to assess research engagement of resident doctors in training and pattern of submission and approval of their dissertation proposal. Methodology: It was a descriptive cross-sectional descriptive study involving resident doctors in accredited hospitals in Northwestern Nigeria. Electronic questionnaires were distributed to respondents via their verified electronic media contacts. Data were collected within a period of 1 month from July 10 to August 6, 2020. Data were analyzed using mean, standard deviation, simple tables as well as Z‐test and Chi‐square test. The level of significance was set at 0.05 for decision purposes. Results: A total of 120 questionnaires were completed. The mean age of respondents was 38.0 ± 3.8 years, with majority being males 88 (83.3%), and 107 (89.2%) being married. Only 12 (10%) and 44 (36.7%) respondents had published manuscript before and since commencement of residency training, respectively. There was a significant difference between manuscript publication before and since commencement of residency training (P = 0.012). Only 32% of the respondents who submitted their dissertation proposal to the colleges did so within 12 months of success in their Part 1 fellowship examination. There was no association between the publication of manuscript during residency training and submission of dissertation to either National Postgraduate Medical College of Nigeria (P = 0.190), West African College of Surgeons (P = 0.686), or West African College of Physicians (P = 0.317). Conclusion: Research engagement by resident doctors from this study was not satisfactory. Publication of manuscript by resident doctors was associated with prior publication before commencement of residency training and type of training hospital

Factors associated with compliance to chemotherapy amongst cancer patients in a radiotherapy facility

Objectives: To study compliance with chemotherapy schedules in cancer patients and associated factors.Study Background: This study was conducted in Radiotherapy/Oncology Department, Ahmadu Bello University Teaching Hospital (ABUTH) Zaria which has a 10-bed capacity chemotherapy room, within 11 weeks from 1st March 2018 to 18th May 2018. Almost all the patients were on 3- weekly cyclical chemotherapy with very few patients on 2-weekly or 4- weekly courses. The hospital serves as a centre of excellence for oncology in the Northern region of Nigeria. The bulk of the patients are from a low socio-economic class.Methodology: The study is a prospective cross-sectional study involving a total of 140 patients. Data collection from patients' record (age, diagnosis, stage at diagnosis, comorbidities, chemotherapy regimen, previous treatments received etc.), the record of the date of chemotherapy course and assessment ECOG performance for each patient during each chemotherapy course were recorded in a designed booklet. This was conducted for over 11 weeks. Ethical clearance was obtained. Patients' consent was obtained, and care was taken to maintain the confidentiality of patients. Data collected were inputted and analyzed using Statistical Program for Social Sciences (SPSS) version 21.0.Results: There was a statistically significant correlation between compliance with chemotherapy schedule and patients' performance status, prior radiotherapy, combination chemotherapy and use of platinum-based chemotherapy regimen. However, there were no correlations with patients' age, sex, chemotherapy course, stage of the disease, previous oncologyrelated surgery (excluding biopsies), comorbidities and blood transfusion during chemotherapy.Conclusion: This study suggests that patients' performance status, prior radiotherapy, use of platinum-based chemotherapy and combination chemotherapy schedule are significant to compliance with chemotherap

Subjective reasons for COVID-19 vaccine hesitancy and sociodemographic predictors of vaccination in Nigeria: an online survey

The purpose of this study was to examine the subjective reasons for hesitancy to receive COVID-19 vaccination and the sociodemographic factors associated with vaccination uptake. An online social media survey was conducted among the general Nigerian population using a self-developed questionnaire. Data were analyzed using binary logistic regression with crude and adjusted odds ratios (AOR) at a 95% confidence interval (CI) and a p value of less than 0.05. A total of 576 participants with a mean age of 31.86 years participated in the study. 28% (n = 158) received one or more doses of the COVID-19 vaccine. Teachers were significantly less likely than health professionals to be vaccinated (AOR = 0.33, 95% CI 0.16–0.69). In addition, unemployed people (AOR = 0.37, 95% CI 0.15–0.89) were less likely to be vaccinated than government employees, and those of intermediate socioeconomic status (AOR = 0.47 95% CI 0.26–0.88) were less likely to be vaccinated than were those of high socioeconomic status. Five main themes emerged regarding participants’ subjective reasons for hesitating to receive the COVID-19 vaccine: fear related to vaccine content (e.g., efficacy), negative effects on the body (e.g., blood clots), distrust of the system/government (e.g., politics), psychological concerns (e.g., anxiety), and misconceptions. Sociodemographic variables and vaccine misconceptions were found to play an important role in COVID-19 vaccination coverage in Nigeria

Health, well-being, and burnout amongst Early Career Doctors in Nigeria.

BackgroundEarly Career Doctors (ECDs) in Nigeria are faced with many individual and systemic problems, which consequently adversely affect their health, well-being, patient care and safety.ObjectiveThis study, the second phase of the Challenges of Residency Training and Early Career Doctors in Nigeria (CHARTING II) Study, sought to examine the risk factors and contributors to the health, well-being and burnout amongst Nigerian ECDs.MethodsThis was a study of health, well-being and burnout amongst Nigerian ECDs. Outcome variables included burnout, depression, and anxiety, which were respectively assessed using the Copenhagen Burnout Inventory (CBI) and Oldenburg Burnout Inventory (OLBI), Patient Health Questionnaire (PHQ-9) depression scale, and Generalized Anxiety Disorder (GAD-7) scale. The quantitative data obtained was analysed using the IBM SPSS, version 24. Associations between categorical outcome and independent variables were assessed using chi square, with level of significance set at ResultsThe mean body mass index (BMI), durations of smoking and alcohol consumption of the ECDs were 25.64 ± 4.43 kg/m2 (overweight range), 5.33 ± 5.65 years and 8.44 ± 6.43 years respectively. Less than a third (157, 26.9%) of the ECDs exercised regularly. The most common disease conditions affecting the ECDs were musculoskeletal (65/470, 13.8%) and cardiovascular diseases (39/548, 7.1%). Almost a third (192, 30.6%) of the ECDs reported experiencing anxiety. Male and lower cadre ECDs were more likely than female and higher cadre ECDs to report anxiety, burnout and depression.ConclusionThere is an urgent need to prioritize the health and well-being of Nigerian ECDs, so as to optimize patient care and improve Nigeria's healthcare indices

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

BackgroundFuture trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050.MethodsUsing forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline.FindingsIn the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]).InterpretationGlobally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions.FundingBill & Melinda Gates Foundation.</p