Methamphetamine (Mkpulummiri) use in eastern Nigeria: A new addition to drug users’ repertoire

Media reports indicate that methamphetamine (mkpulummiri) use is growing among young people in Eastern Nigeria, but empirical research has not been conducted. This article reviews the recent media reportage of methamphetamine use in Eastern Nigeria, presents an empirical account of a methamphetamine user, and synthesizes the available evidence, showing the factors facilitating its use. Available evidence shows that drug trafficking and illegal laboratories are the two main factors encouraging current methamphetamine availability and use in Eastern Nigeria. The NDLEA has discovered illegal laboratories where methamphetamine is produced in Enugu and Asaba. These laboratories were established by drug barons from Eastern Nigeria and their foreign counterparts. Therefore, it is logical to conclude that these local laboratories have largely contributed to the growing methamphetamine epidemic. Media reports indicate that youth organizations and vigilante groups apply corporal punishment by flogging identified users in public but do not highlight how effective this sanction is. While empirical data show that weight control motivates methamphetamine use, the grey literature has blamed youth unemployment. There is an urgent need to conduct empirical research to determine methamphetamine prevalence, the sources, motivations for use, and consequences in Eastern Nigeria. This will facilitate the design of effective interventions to reduce the growing trend. Efforts to discover and dismantle illegal laboratories should not only focus on cities because laboratories set up to evade detection may exist in rural settings. It is vital that the government work with all stakeholders to increase public awareness of the dangers of methamphetamine use in Nigeria and develop mechanisms to support addiction treatment and rehabilitation to prevent social stigma users may face

Gender variations in specialties among medical doctors working in public healthcare institutions in Bayelsa State, Nigeria

Background: Gender variations exist in the choice of specialties among doctors globally. This variation is of public health importance as it affects the distribution of doctors in public health institutions and patient care. In Bayelsa, Nigeria,no such study had been undertaken.This study aimed to examine gender variations in specialties among medical doctors working in public healthcare institutions in Bayelsa State.Methods: Cross-sectional study design was adopted for this study. Information about doctors working in public healthcare institutions in Bayelsa were collected via data extraction from the register of doctors at Niger Delta University Teaching Hospital (NDUTH) and at Hospital Management Board (HMB) of State Ministry of Health, and with self-completed questionnaires from doctors at Federal Medical Centre (FMC). In this paper, statistical analyses were restricted to data from FMC (n=91) and NDUTH (n=100) because they have multiple specialties. All available data were analyzed by gender and data analyses were carried out using SPSS statistical software.Results: Out of the191 doctors included in the analysis, 135(70.7%) were males. The median age was 32 years for male doctors and 29 years for female doctors.The top three specialty choices for males were obstetrics and gynaecology (14.8%),internal medicine (11.1%) and surgery (8.9%). For female doctors,pediatrics was the topmost specialty (25%) followed by obstetrics and gynaecology (10.7%) and internal medicine (8.9%). There were no female doctors in 14 specialties. Female doctors had higher proportions of house officers compared to males (45.5% versus 32.3% respectively). Conversely, male doctors had higher proportions of consultants/specialists than females (24.1% versus 9.1% respectively).Conclusion: Specialty distribution of doctors in Bayelsa is gendered and some specialties appear not to attract female doctors. These findings call for further studies to investigate the factors responsible for this gender variation, and to identify and address any barriers.Keywords: Gender variation,Specialties,Doctors,Public healthcare,Health workforc

Characteristics of medical doctors working in public healthcare institutions in a southern Nigerian state

Objective: This study assessed the characteristics of medical doctors working in public healthcare institutions and examined differences in some of the characteristics by geographical (urban versus rural) location.Methods: A cross-sectional study of doctors working in public healthcare institutions using data obtained from 3 centres in Bayelsa, Nigeria.Results: Three-quarters (75.4%) of the 280 medical doctors were males. Most of the doctors (68.6%) were working at tertiary healthcare level, 16.1% at primary and 15.4% at secondary healthcare levels. In terms of their professional positions, there were more medical officers (34.5%) relative to the other cadres while 17.2% were consultants. When their places of practice were dichotomised into rural and urban settings, 88.2% were practising in urban settings. A higher proportion of the 69 female doctors were practising in urban settings compared to rural settings (26.7% versus 9.1% respectively, P=0.027). There was a statistically significant relationship between residency status and place of practice (P=0.001). Specialists  (i.e. doctors who have completed residency training) were more likely to practice in urban (19.2%) than in rural settings (3.3%).Conclusion: Only a quarter of doctors in this study were females. There seemed to be more doctors at tertiary level of care and in urban areas. These findings suggest that there may be a shortage of female doctors, and that there may be unmet personnel needs at primary and secondary healthcare levels and in rural areas.Keywords: Health services, Human resources for heath, Health workforce, Geographical Distribution, Medical Doctor

Perception of substance use disorder training: a survey of general psychiatry residents in Nigeria

OBJECTIVE: Substance use disorder (SUD) is a global concern. Evidence from high-income countries suggests that SUD training for psychiatry residents is less than optimal but it is unknown whether the situation is different in low-/middle-income settings. This study assessed psychiatry residents' perception of their SUD training. METHODS: A cross-sectional survey was conducted among general psychiatry residents in Nigeria from November 2018 to May 2019. Data were collected through self-completion of an English-language questionnaire with multiple-choice and open-ended questions administered face-to-face and online. RESULTS: A total of 51 participants completed the questionnaire, mean age 33.6 years and 76.5% men. Most participants (70.6%) expressed interest in addiction psychiatry, and 47.1% perceived their SUD training as inadequate. When asked to rate satisfaction with the SUD training they have received so far, 52.9% were unsatisfied, and the absence of in-house SUD training (29.4%) was the leading cause of dissatisfaction. For those who were satisfied, the most common reasons were availability of SUD training and treatment-related factors (31.4%). The most frequent suggestions for making addiction psychiatry subspecialty attractive to psychiatry residents were provision of SUD treatment units, structured SUD training, and continuity of such training. Equipping existing SUD treatment units and creating more treatment units were the most common suggestions for improving current SUD training. CONCLUSION: This study demonstrated a high level of interest in addiction psychiatry, but satisfaction with SUD training was mixed. Addressing causes of dissatisfaction and areas suggested for improvement would be necessary to sustain interest

Socio-Demographic Factors Influencing the Use of Assistive Technology among Children with Disabilities in Malawi

Abstract: This paper aims to address the information gap on the influence of socio-demographic factors on access and utilization of Assistive Technology (AT) among children with disabilities in Malawi. Thus, it contributes towards the realization of the recommendations of the UN Convention on the Rights of Persons with disabilities and the development of a framework for creating an effective national AT policy. The paper used two statistically matched datasets, namely, the 2017 survey on Living conditions among persons with disabilities in Malawi and the 2015-16 Malawi Demographic and Health survey. Logistic regression and structural equation modeling techniques were utilized to assess the influence of socio-demographic factors on the use of AT among children with disabilities. The results indicate that there is a high level of unmet need for AT among young children aged 2 to 9 and those living in urban areas. The results further indicate that children with multiple disabilities have lower odds (OR = 0.924) of using AT for personal mobility compared to children with a single functional difficulty. These results entail that AT needs for children with multiple disabilities are not adequately addressed. Therefore, when developing policies on AT, younger children and those with multiple disabilities need to be specifically targete

A review of innovation strategies and processes to improve access to AT: Looking ahead to open innovation ecosystems.

It is essential to understand the strategies and processes which are deployed currently across the Assistive Technology (AT) space toward measuring innovation. The main aim of this paper is to identify functional innovation strategies and processes which are being or can be deployed in the AT space to increase access to AT globally. We conducted a scoping review of innovation strategies and processes in peer-reviewed literature databases and complemented this by identifying case studies demonstrating innovation strategies. The review includes WHO world region, publication year, AT type and a sector analysis against the Systems-Market for Assistive and Related Technologies Framework. We analyzed the case studies and interviews using thematic analysis. We included 91 papers out of 3,127 after review along with 72 case studies. Our results showed that product innovations were more prevalent than provision or supply innovations across papers and case studies. Case studies yielded two themes: open innovation (OI); radical and disruptive innovation. Financial instruments which encourage OI are needed and we recommend pursuing OI for AT innovation. Embedding AT within larger societal missions will be key to success governments and investors need to understand what AT is and their translational socioeconomic value

Addressing challenges in addiction treatment and training in Africa

Substance use disorder is a major contributor to disability adjusted life year. Globally and especially in Africa there is high treatment gap for substance use disorders (SUDs) and lack of training in addiction psychiatry. This commentary discusses challenges to SUD treatment and training in Africa and offers suggestions to advance the field. Socio-political and health system factors limit the availability of treatment and training of healthcare providers for addiction in Africa. It is essential that governments in Africa prioritise investment in addiction treatment and training to reduce the morbidity and mortality associated with lack of treatment

Implications of silence in the face of child sexual abuse: observations from Yenagoa, Nigeria

Child sexual abuse (CSA) is common globally but underreported. It has far-reaching physical, social, and mental health effects and often the victims suffer in silence because of the shame and stigma associated with the experience. Despite international and country specific legislation to protect children and punish offenders, CSA thrives and sometimes leads to the death of victims. We report two cases of children aged 7 and 8 who presented at Niger Delta University Teaching Hospital Bayelsa, Nigeria. In both cases, the offender was known to the victim‘s parents who did not only refuse to report the cases to law enforcement agents but also discontinued medical follow-up for the children. These cases highlight that in cases of CSA, parents and families often prefer silence rather than confronting offenders or reporting incidents to law enforcement agencies. This choice of inaction only promotes the ill. It is essential that laws and regulations meant to protect children locally and internationally are implemented to end the scourge of CSA and its many effects.Keywords: Children, sexual abuse, implications of silence, parent

Effectiveness of depression interventions for people living with HIV in Sub-Saharan Africa:A systematic review & meta-analysis of psychological & immunological outcomes

This meta-analytic review evaluated the effectiveness of depression interventions on the psychological and immunological outcomes of people living with HIV in sub-Saharan Africa. 14 studies, yielding 932 participants were eligible. A random-effects models indicated that depression interventions were followed by large reductions in depression scores (effect size = 1.86, 95% CI = 1.71, 2.01, p < 0.01). No significant effect on immune outcome was observed, however there was a trend toward immune improvement of medium effect size (effect size on CD4 count and/or viral suppression = 0.57, 95% CI = −0.06, 1.20, p = 0.08). Pharmacological interventions appeared to have a significantly larger improvement in depression scores than psychological interventions. The greatest improvement in immune status was demonstrated in psychological treatments which incorporated a component to enhance HIV medication adherence, however these results did not reach significance. Small sample sizes and highly heterogeneous analysis necessitate caution in interpretation. The results of this meta-analysis should thus be treated as preliminary evidence and used to encourage further studies of immunopsychiatry in HIV in sub-Saharan Africa