Patients’ satisfaction with the quality of services accessed under the National Health Insurance Scheme at a Tertiary Health Facility in FCT Abuja, Nigeria

Background: Evaluation of patients’ satisfaction is increasingly gaining importance as one of the main tools for the assessment of the quality of healthcare delivery and its impact from the patients’ perspective. This study assessed patient satisfaction with services accessed under the National Health Insurance Scheme at a tertiary health facility in FCT Abuja, Nigeria.Methods: A cross-sectional study was conducted among NHIS patients attending the General Outpatient Department at the National Hospital FCT Abuja, Nigeria between April and September 2017. Data was collected from 388 patients selected by systematic random sampling; using pretested, anonymous, self-administered, structured questionnaires, with each satisfaction area scored on a five-point Likert scale ordinal response. Evaluation was done from the typical complaints received from NHIS enrollees such as: hospital reception and patient registration process, waiting time, doctors’ consultations, laboratory services, availability of prescribed drugs and hospital facilities. Data analysis was done using IBM SPSS Statistics 20.0.Results: The overall average satisfaction score was 58.1%. The satisfaction score with various aspects of services were: doctors’ consultation (69.9%), laboratory services (66.5%), hospital facilities (62.2%), hospital services (60.4%), reception/registration (59.8%), waiting time (59%) and prescribed drugs (54.2%).Conclusion: The patient’s overall satisfaction was good. However, unavailability of prescribed drugs, long registration processes and waiting time were found to be the major causes of dissatisfaction. Therefore concerted efforts should be directed by all stakeholders towards the areas of patient dissatisfaction through better service delivery.Keywords: Patient Satisfaction, Services, Health insurance, Health facility, Nigeri

Operations and roles of patent and proprietary medicine vendors in selected rural communities in Edu Local Government Area, Kwara State, north-central Nigeria

Background: Patent and Proprietary Medicine Vendors (PPMVs) are a ubiquitous feature of the informal health sector in many African countries including Nigeria. Little has been reported about the services they render. This study assessed the operations and role of PPMVs in selected rural communities of Edu LGA, Kwara State, NigeriaMethods: This explorative study used a mixed method approach of data collection. In-depth interviews were conducted among 25 purposively selected PPMVs in three out of the five operational zones in the LGA. Enumeration and mapping of PPMVs shops was done to determine the number and location of the PPMVs in all the five operational zones in the LGA.Results: PPMVs sell drugs with or without prescription and offer services like weight, blood pressure measurements. Products stocked align with the approved list of drugs, though some stock drugs outside the list. Their collaboration with the pharmacists is limited to drug purchasing. Collaboration with the formal health sector consists of training and patients’ referrals. Membership of National Association of Patent and Proprietary Medicine Dealers (NAPPMED) is a ‘sine qua non’ for business. Enumeration of PPMVs shops in the five zones revealed 136 shops with Lafiagi having the highest and the GPS coordinates mapped on Google Earth Map showed the location and spread of the PPMVsConclusion: PPMVs can potentially bridge the gap in healthcare delivery in the study area and by extension to the State. Organizing capacity building workshops for the PPMVs can help strengthen their quality of health service and collaboration with other stakeholders.Keywords: Patent medicine, Pharmacies, Proprietary medicine vendors, Rura

Evaluation of Patients' Satisfaction with Services Accessed under the National Health Insurance Scheme at a Tertiary Health Facility in North Central, Nigeria.

Background: The evaluation of patient satisfaction provides an indicator of quality of care and contributes to strategies towards improvement of healthcare delivery.Objective: To assess patient satisfaction with services accessed under the National Health Insurance Scheme at a tertiary health facility in North central, Nigeria.Methodology: A cross-sectional study with a sample size of 421 NHIS enrollees between ages 18 to 60 years was done from December 2015 to January 2016 at Federal Medical-Centre, Keffi, Nasarawa-State, Nigeria. Patients were selected by Systematic random sampling. Data was collected using pretested, anonymous, self-administered, structured questionnaires, with each satisfaction area scored in a five-point Likert scale ordinal response. The dimensions of health services evaluated were based on the typicalcomplaints received from NHIS enrollees such as; hospital accessibility, reception and patient registration process, waiting time, doctors' consultations, availability of prescribed drugs, hospital staff attitudes and hospital facilities. Analysis was done using EPI INFO version 3.5.4.Results: The overall average satisfaction score was 63.1%. The respondents expressed satisfaction with various aspects of services; reception/registration (65.3%), waiting time (57.4%), doctors' consultation (70.5%), prescribed drugs (55.3%), laboratory services (71.6%), condition of hospital facilities (60.3%) and staff attitude (61.0%).Conclusion: This study showed that the overall patients' satisfaction with services accessed was good. However, there is the need for the NHIS and healthcare facilities to continuously improve on the provision of healthcare services and address areas of dissatisfaction

Self-reported medical care seeking behaviour of doctors in Nigeria

AbstractBackgroundThere is need for information on the medical care seeking behaviour of Nigerian doctors.PurposeThis work was therefore designed to study the medical care seeking behaviour of Nigerian doctors in Nigeria.MethodsIt was a cross-sectional survey among doctors in Nigeria.ResultsData from 522 doctors were included in the analysis. Majority of them (80.5%) had one form of illness or the other in the year preceding the survey. Only 35% of them reportedly consulted another doctor during their illness. Most of the consultations (61.2%) were informal in the form of over the phone (45.6%), Corridor (33.3%) and home visit (21.1%) and just 18.4% of the consultations occurred within 24h of onset of illness. A low 19.5% of them had a regular source of medical care. Screening for illnesses was generally below expectation. Just 6 out of the 436 (1.4%) male doctors had screened for prostate cancer while 39 out of 86 (45.3%) females had screened for cervical cancer. A significantly higher proportion of general practitioners (p=0.01) and doctors above 45 years of age (P=0.004) consulted informally. Higher proportion of general practitioners and resident doctors based their consultations on their familiarity with the doctors consulted (p=0.001) and privacy during consultation (p=0.001). Delay in consultation for more than 24h after onset of illness was more likely in those above below the age of 45 years (p=0.001).ConclusionThis study has shown that Nigerian doctors are often reluctant patients who frequently tend to delay medical care. The teaching of appropriate medical care seeking behaviour should be incorporated into medical curriculum in Nigeria

Adherence to prescribed drug therapy among adult patients of General Out-Patient Department of a Tertiary Hospital in Nigeria

Objective: The widespread problems of adherence to medication denied substantial number of patients the maximum benefits of medical treatment, resulting in poor health outcomes, lower quality of life and increased health care costs. The objective of this study was to determine the extent of drug adherence among patients seen in a tertiary hospital in Nigeria.Methods: The study was a descriptive cross-sectional survey carried out among 381 patients attending the General Out-Patient Department (GOPD) of a Teaching Hospital in Nigeria. Interviewer administered questionnaire was used as the research tool and case notes of the patients were used to obtain information on drug adherence.Results: About half of the patients 194 (50.9%) adhered fully with doctor's prescription on the use of drugs for diseases they presented to the  hospital. More than three quarters (78.0%) of patients aged 56 years and above adhered fully with prescription compared with 11.1% in the age group 15-25 years. The older patients had better adherence to medication than the younger patients with a statistically significant difference (p = 0.001). Many of the patients with no formal education (69.0%) adhered fully with prescription compared with 28.6% with post secondary education p = 0.001.Conclusion: Health education intervention and active role of health care providers in patients'-provider  communication towards addressing the determinants of non-adherence will play a major role in improving adherence to medication.Key words: Drug, adherence, Teaching, Hospital, Nigeri

Availability and utilization of drug information center, drugs and therapeutic committee and standard treatment guidelines in the management of HIV/AIDS patients at public hospitals in a north-central state, Nigeria

Introduction: Nigerian National Drug Policy has targets with regards to institutionalization of Drug Information Center (DIC), Drugs and Therapeutic Committee (DTC) and Standard Treatment Guidelines (STGs). Inadequate availability and utilization of these supporting policies/documents affect quality of healthcare.Objective: This study examined the availability and utilization of DIC, DTC and STGs in the management of HIV/AIDS patients at public hospitals in a North-Central State, Nigeria.Methods: This qualitative multi-center study involved in-depth interviews of eligible 10 prescribers and 7 dispensers who provided healthcare to HIV/AIDS patients in eligible public hospitals with the aid of structured interview guide. The interviews were audio-taped, verbally transcribed, analyzed and developed into ethnographic summary.Results: Among the prescribers, STGs was the most available and utilized supporting policy/document. Less than 50% of the prescribers had DTC and DIC available in their institutions, less than 50% utilized DTC while only one prescriber utilized the available DIC. Only 10% of the prescribers had and utilized all three (STGs, DTC and DIC). Also, STGs was available to and utilized by all the dispensers. However, only 14.3% of the dispensers had DTC and DIC available in his institution and utilized them. Reasons for utilization/non-utilization of DIC, DTC, and STGs were awareness of availability, patient workload and documentation workload.Conclusion: Availability and utilization of STGs are optimal. However, availability and utilization of DIC and DTC in the management of HIV/AIDS patients in Public Hospitals are below optimal. There is need for improved availability and institutional mechanisms to ensure their utilization.Keywords: Availability, Utilization, Drug Information Center, Drugs and Therapeutic Committee Standard Treatment Guidelines, HIV/AIDS Patient

Rapid Assessment as an Evaluation Tool for Polio National Immunisation Days in Brong Ahafo Region, Ghana

Background: Despite reported high coverage of National Immunization Days (NIDs) campaign in many countries children are still being missed during these campaigns. This is a study of a rapid assessment done to determine OPV coverage during an immunization campaign. Methods: In this descriptive cross-sectional study, regional supervisors in Brong Ahafo region of Ghana visited randomly selected houses during the first round of the Polio NIDs in October 2004 to identify under-5 children that were reached with OPV vaccines in the households and those missed during the campaign. Results: In the 13 districts a 1607 houses visited by regional supervisors for rapid assessment, volunteers did not visit 4 (0.24%) houses. There were 3737 under five in all the houses visited by the supervisors for rapid assessment out which 42 (1.2%) were missed and unvaccinated and the reason was that the children were not at home. The assessment showed that the main sources of information to mothers / caretakers on NIDs were Gong-gong and radio. The assessment provided opportunities to identify proportion of children missed and ensure necessary intervention to reach them. Conclusion: Rapid assessment is a valuable tool for evaluation of NIDs; it enables timely intervention in covering missed children and helps in careful interpretation of the usual over 100% coverage often recorded during NIDs. It is recommended that this be practiced widely to improve quality of NIDs for early global eradication of poliomyelitis.Contexte : Malgr\ue9 la haute couverte rapport\ue9e lors des campagnes nationales d'immunisation, dans plusieurs pays des enfants sont toujours rat\ue9s par ces campagnes. Nous proposons une estimation rapide de la couverture durant une campagne d'immunisation. M\ue9thodes : Dans cette \ue9tude descriptive sur un \ue9chantillon repr\ue9sentatif, des maisons choisies au hasard ont \ue9t\ue9 visit\ue9 par les superviseurs r\ue9gionaux de la r\ue9gion de Brong Ahafo, Ghana lors du premier passage des journ\ue9es nationales d'immunisation contre la Polio en Octobre 2004. Il s'agissait d'identifier les enfants de moins de 5 ans ayant re\ue7u le vaccin dans ces maisons et d'identifier ceux qui n'ont pas \ue9t\ue9 vaccin\ue9s dans cette campagne. R\ue9sultats : Dans 13 districts, un total de 1607 maisons visit\ue9es par les superviseurs r\ue9gionaux, pour estimation rapide. Quatre maisons (0,24%) n'avaient pas \ue9t\ue9 visit\ue9es par les volontaires. Il y'avaient 3737 enfants de moins de 5 ans dans l'ensemble des maisons visit\ue9es par les superviseurs, parmi eux 42 (1,2%) n'avaient pas \ue9t\ue9 vaccin\ue9s et la raison \ue9taient que ces enfants \ue9taient absents de la maison. L'\ue9valuation avait montr\ue9 que les principales sources d'information des mamans/gardiens lors des journ\ue9es nationales d'immunisation \ue9taient les Gong-gong et la radio. L'estimation avait donn\ue9 des opportunit\ue9s pour la d\ue9termination de la proportion d'enfants non vaccin\ue9s et des interventions \ue0 faire afin d'atteindre ces enfants. Conclusion : L'estimation rapide est un instrument important pour l'\ue9valuation des journ\ue9es nationales d'immunisation, elle permet des interventions opportunes pour couvrir les enfants manqu\ue9s. Elle permet aussi de faire une interpr\ue9tation prudente du taux de couverture de 100% habituellement rapport\ue9 durant ces journ\ue9es nationales d'immunisation. Il est recommand\ue9 de vulgariser cette v\ue9rification afin d'am\ue9liorer la qualit\ue9 de ces journ\ue9es nationales d'immunisation pour une \ue9radication globale de la poliomy\ue9lite

Survivorship patterns of histopathological variants and molecular subtypes of breast cancer in a teaching hospital in Nigeria

Objective: To study the relationship of histopathological characteristics, molecular subtypes of breast cancer and survival in a low resource setting.Design: Tumours from prospectively ascertained patients newly diagnosed with breast cancer were analyzed. Formalin-fixed and paraffin-embedded sections were constructed into tissue micro-arrays and immunostained with five anti-bodies. Five molecular subtypes were determined.Settings: The study was conducted jointly in the Department of Pathology of University of Ilorin Teaching Hospital, Ilorin in Nigeria and at the University of Chicago in the United States.Subjects: The study included a total of 203 histologically confirmed breast cancer patients whose pathological specimens were processed in the Department of Pathology of University of Ilorin Teaching Hospital, Ilorin, Nigeria between January 2003 and December 2007.Results: Mean age at diagnosis was 49.2 (SO ±11.9) years. Median time from symptom onset to cancer diagnosis was six months. Median follow-up time was 8.3 months. Median tumour size at diagnosis was 6cm. The proportion of ER+, PR+, HER2+ tumours were 27%, 16% and 30%, respectively. The most common molecular subtype was basal-like (25.1%) followed by unclassified (24.0%), luminal A (20.5%), HER2+/ER( 19.3%) and luminal B (11.1 %). Luminal A and B had best prognosis while basal-like and unclassified had worst prognosis. ER+ patients had longer duration of symptoms to diagnosis (median 8 months) than ER- patients (5 months) but ER+ patients had smaller tumours (median 5cm) than ER-patients (6cm, p=0.02). Recurrence-free survival was best for stage 1 and worst for stage 4 tumours. About 32.6% of patients had locoregional and/or metastatic recurrence.Conclusions: In consecutive breast cancer cases in Nigeria, almost half of patients were triple negative. Luminal A and B subtypes had best prognosis while triple negative had worst prognosis. The delay in breast cancer diagnosis and higher proportion of late stage of breast cancer underscores need for prompt diagnosis and initiation of treatment, especially hormonal therapy for ER positive patients

Predictors of vaccine management practices among primary healthcare workers (PHCWs) in Ilorin, North Central Nigeria

Objective: Worldwide, vaccines are becoming more expensive as new ones are being introduced to the immunization schedule. Inspite of this, researches have revealed poor vaccine management practices among health workers. This study aimed to determine the predictors of vaccine management practices among PHCWs providing routine immunization services in static health facilities in Ilorin, north central Nigeria.Methods: This quasi-experimental study was conducted among 216 intervention and 241 control groups of PHCWs using multi stage sampling technique; pretested questionnaire and an observational checklist. Data were analyzed using EPI-INFO software package. Level of significance was predetermined at a p-value of less than 0.05.Results: The mean age of study respondents was 38.5 ± 9.5 years. Factors having positive influence on vaccine management practices include prior training exposure (p = 0.001), years of experience in immunization (p = 0.012) and baseline knowledge of vaccine management (p = 0.015). In addition, regularity of supervisory visit (0.008), adequacy/regularity of vaccine supply (p = 0.001), vaccine 'bundling' (p = 0.013) and type of health facility (p = 0.005) positively influenced respondents' vaccine management practices. However, basic qualification of health workers (p = 0.096) and availability of data tools (p = 0.628) had no significant influence on respondents' vaccine management practices.Conclusion: Training exposure and years of experience in routine immunization have positive influence on vaccine management practices of PHCWs. On-the-job supervision of health workers should be conducted at least bi-annually.Keywords: Predictors, Vaccine management practices, PHCW

Knowledge of blood donation among adults in north-central Nigeria

Background: About half of the population in Nigeria is medically fit for blood donation but only four in one thousand are voluntary donors. The low level of blood donation has been attributed to poor knowledge, misconceptions, myths, bias, poverty, fear, malnutrition among the population. Therefore, this study assessed the knowledge of blood donation among adults in two selected North Central States of Nigeria.Methods: It was a descriptive cross-sectional study. A total of 3104 respondents comprising of adults between 18 and 60 years were involved in the study. A multistage sampling technique was used and the research tool was interviewer-administered questionnaire. The data generated were entered into the computer and subjected to appropriate statistical analysis using EPI INFO computer software package (version 3.5.3). Pearson Chi Square (χ2) was used to test statistical significance and p-value was set at < 0.05.Results: Majority of the respondents 2565 (82.5%) knew that blood donation save lives. More than three-quarters, 2468 (79.5%), knew where to go for voluntary blood donation. About one-third, (37.1%), demonstrated good knowledge of voluntary blood donation. Older respondents (>60 years) had poor knowledge of blood transfusion compared with younger age groups (p<0.001). Respondents’ occupation and educational status were significantly associated with knowledge of blood transfusion (p<0.001)Conclusion: Periodic awareness programme on voluntary blood donation in rural and urban areas across Nigeria is needed. In addition, sensitization of the informal sector on the significance of non-remunerated voluntary blood donation should be given priority.Keywords: Knowledge, Blood, Donation, North-Central, Nigeri