'Gift with a price tag': Nigerian egg donors' knowledge, experiences and motivations

Research around the world has indicated that the demand for egg donation has grown considerably among young females. This study qualitatively examines the knowledge, experiences, and motivations of young egg donors at a Nigerian health facility. Indepth interviews were conducted in Igbo and English with consenting thirty-one egg donors attending a fertility clinic in Anambra State, south-eastern Nigeria. Data were collected and analysed to generate themes with the aid of NVivo 10 software. Three themes were identified from the participants' motivations and include (a) monetary (93.6%), (b) altruistic (3.2%), and (c) both monetary and altruistic reasons (3.2%). Findings highlighted that the differences were based on a variety of reasons in Nigeria. All the participants were literate and single, and the majority received payment. The majority (77.4%) of those who received payment mentioned that the payment was not worth the donation program. The participants preferred to be anonymous because they had not discussed their donation with their family members, and the non-acceptance of egg donation program by the Nigerian society. Given that the market for egg donation has become a common method of infertility management in Nigeria, our findings have important implications for practices, policy actions, and future research. (Afr J Reprod Health 2022; 26[6]:64-79).

Motivated strategies for learning and their association with academic performance of a diverse group of 1st-year medical students

Background. Most instruments; including the well-known Motivated Strategies for Learning Questionnaire (MSLQ); have been designed in western homogeneous settings. Use of the MSLQ in health professions education is limited. Objective. To assess the MSLQ and its association with the academic performance of a heterogeneous group of 1st-year medical students.Methods. Eighty-three percent of 1st-year medical students consented to participate in this quantitative study. The MSLQ consisted of a motivation strategies component with six subscales; while the learning strategies component had nine subscales. Demographic and academic achievement information of the students was also collected. Stata version 13 (StataCorp LP; USA) was used for the statistical analyses of all data.Results. Female students displayed significantly higher motivational scores. Students with prior educational experience and those who attended peer-mentoring sessions had significantly higher learning strategy scores. Significant but moderate relationships were found between academic performance and the motivation strategies subsumed within the categories 'task value' and 'self-efficacy for learning performance'. In terms of the 'learning strategy component'; 'critical thinking'; and 'time and study environment'; the composite score was significantly but poorly correlated to academic performance. Conclusion. Overall; limited correlations were found between the MSLQ scores and academic performance. Further investigation of the use of the MSLQ and its association with academic achievement is recommended; with greater focus on specific learning events than on course outcomes. This study highlights the importance of evaluating an instrument in a specific context before accepting the findings of others with regard to the use of the instrument and its correlation with academic performance

Hospital Reform and Staff Morale in South Africa: a Case Study of Dr Yusuf Dadoo Hospital

Objectives: This study explored major factors that influenced staff motivation at a district hospital in South Africa following hospital reforms and comparison of these factors across the two main staff categories. Design: This study was a cross-sectional descriptive survey. Settings and subjects: This study included all medical and nursing staff working at the district hospital. Outcome measures: A semi-structured questionnaire coded for anonymity was used. It comprised three sections: the introduction; demographic information and a list of factors to which participants responded by indicating their level of agreement or disagreement using the Likert's scale. The questionnaire's reliability was confirmed using Cronbach's coefficient alpha with a value of 0.9. Results: Of the 179 participants; 122 returned the questionnaires. This equated to a response rate of 68. The staff expressed more demotivation than motivation. Major factors that played a role were institutional in character; namely poor management and leadership; unfavourable institutional policies and administration practices with regard to staff development; conflictual inter- and intraprofessional relationships; a paucity of equipment and retention and recruitment strategies. The unique motivator was the individual value of the vocational aspect of the profession. Distance travelled to the workplace did not have any association with the identified motivating and demotivating factors. Conclusion: Staff mo tivation is crucial in any institution or organisation. Presently; the South African healthcare sector is undergoing transformation in terms of implementation of National Health Insurance. The effectiveness of the healthcare system in achieving its goals will be impacted by the prioritisation of institutional strategies that contribute to staff motivation. Managers' skills in healthcare facilities are critical to the success of the implementation of reforms in South Africa

Motivation and job satisfaction of Health Surveillance Assistants in Mwanza; Malawi: an Explorative Study

Aim: Improving community health worker's performance is vital for an effective health system in developing countries. In Malawi; hardly any research has been done on factors that motivate this cadre. This qualitative assessment was undertaken to identify factors that influence motivation and job satisfaction of health surveillance assistants (HSAs) in Mwanza district; Malawi; in order to inform development of strategies to influence staff motivation for better performance. Methods Seven key informant interviews; six focus group discussions with HSAs and one group discussion with HSAs supervisors were conducted in 2009. The focus was on HSAs motivation and job performance. Data were supplemented with results from a district wide survey involving 410 households; which included views of the community on HSAs performance. Qualitative data were analysed with a coding framework; and quantitative data with the Statistical Package for Social Sciences (SPSS).Results The main satisfiers identified were team spirit and coordination; the type of work to be performed by an HSA and the fact that an HSA works in the local environment. Dissatisfiers that were found were low salary and position; poor access to training; heavy workload and extensive job description; low recognition; lack of supervision; communication and transport. Managers and had a negative opinion of HSA perfomance; the community was much more positive: 72.9of all respondents had a positive view on the performance of their HSA. Conclusion Activities associated with worker appreciation; such as performance management were not optimally implemented. The district level can launch different measures to improve HSAs motivation; including human resource management and other measures relating to coordination of and support to the work of HSAs

Factors Associated With the Motivation of Community Drug Distributors in the Lymphatic Filariasis Elimination Programme in Kenya

Annual mass drug administration (MDA) is the main strategy for elimination of lymphatic filariasis (LF); globally. In Kenya; community drug distributors (CDDs) are used to deliver drugs to household members. To determine factors influencing CDDs' motivation; a retrospective cross-sectional study based on qualitative data was conducted in Kwale and Malindi districts after the 2008 MDA. In Kwale; Tsimba location represented high and Gadini low compliance while in Malindi; Goshi and Gongoni locations represented high and low compliance areas; respectively. Fifteen CDDs; 80 opinion leaders; 80 LF patients; five health personnel; four LF coordinators and the National Programme Manager were purposively selected and interviewed. Sixteen focus group discussions (FGDs) were conducted with single-sex adult and youth male and female groups. The factors that possibly had a positive influence on CDDs' motivation were: higher education level; trust and familiarity with community members. All CDDs reported that getting recognised; being trained on LF and an innate desire to help their communities raised their motivation. Factors that possibly had negative influence included: inadequate training; drug supplies and community sensitisation and lack of supervision. The majority of the CDDs reported a lack of or outdated record-keeping books; a limited drug distribution period; inadequate moral support and incentives as negative factors on their motivation. Factors that motivate CDDs are those that enhance their capacities to perform their duties and endear respect in the communities where they serve

Application of the Information; Motivation and Behavioural Skills Model for Targeting HIV Risk Behaviour amongst Adolescent Learners in South Africa

This paper discusses the application of an information; motivation and behavioural skills (IMB) model in a school-based programme for the reduction of HIV risk behaviour among 259 Grade 11 learners in two high schools in Alexandra township; Johannesburg. School 1 was the Experimental group; while School 2 was the Control group. After a baseline study (Time 1) at both schools; a 3-week intervention programme was conducted at School 1. A post-test (Time 2) was conducted at both schools. The intervention was repeated at School 2; followed by another post-test (Time 3) at both schools. A final test (Time 4) was conducted at both schools. While there were positive changes in the levels of HIVetAIDS IMB in learner participants; these changes may not be entirely attributed to the intervention. If an IMB model-based intervention is to be maximally effective in reducing HIV-risk behaviour among adolescents; it must focus on the behavioural; structural and socio-cultural contexts in which adolescents live

Rural practice preferences among medical students in Ghana: a discrete choice experiment

Objective To determine how specific job attributes influenced fourth year medical students' stated preference for hypothetical rural job postings in Ghana.Methods Based on discussions with medical student focus groups and physicians in practice and in the Ministry of Health; we created a discrete choice experiment(DCE) that assessed how students' stated preference for certain rural postings was influenced by various job attributes: a higher salary; free superior housing; an educational allowance for children; improved equipment; supportive management; shorter contracts before study leave and a car. We conducted the DCE among all fourth year medical students in Ghana using a brief structured questionnaire and used mixed logit models to estimate the utility of each job attribute. Findings Complete data for DCE analysis were available for 302 of 310 (97) students. All attribute parameter estimates differed significantly from zero and had the expected signs. In the main effects mixed logit model; improved equipment and supportive management were most strongly associated with job preference (a = 1.42; 95 confidence interval; CI: 1.17 to 1.66; and a = 1.17; 95CI: 0.96 to 1.39; respectively); although shorter contracts and salary bonuses were also associated. Discontinuing the provision of basic housing had a large negative influence (a = .1.59; 95CI: .1.88 to .1.31). In models including gender interaction terms; women's preferences were more influenced by supportive management and men's preferences by superior housing. Conclusion Better working conditions were strongly associated with the stated choice of hypothetical rural postings among fourth year Ghanaian medical students. Studies are needed to find out whether job attributes determine the actual uptake of rural jobs by graduating physicians

Behaviour change and motivational interviewing in the patient with diabetes

Motivational Interviewing (MI) is designed to motivate people to change by helping them to recognise and resolve the difference between a behaviour problem and personal goals and values. There are several challenges of health behaviour change in MI; as well as traps that the health care provider and patient can easily fall into. During the MI approach; a patient should be guided through the change model; providing him the chance to participate. There are several general principles in the MI approach as well as different interaction techniques. The efficacy of MI has been widely published in the literature

Reasons for Doctor Migration from South Africa

Background: The migration of doctors from their home countries is not a new phenomenon. Apart from voluntary migration due to various reasons; medical professionals; often from sub-Saharan Africa; are actively recruited by developed countries. Doctors in South Africa are esteemed for the high standard of training they receive locally; a quality which renders them prime candidates for employment. Various factors are involved in the push-pull theory of migration. It has; however; been reported extensively that push factors usually play a much greater role in doctors' decision to leave their countries of origin; than the pull factors in the host or recipient country. Push factors motivating migration most frequently include dissatisfaction with remuneration packages and working conditions; high levels of crime and violence; political instability; lack of future prospects; HIV/AIDS; and a decline in education systems. In addition to a depletion of intellectual resources through losing highly qualified and skilled individuals; source countries also face substantial monetary implications caused by the migration of doctors. The cost of training medical students is subsidised by the government; and could be regarded as a lost investment when young graduates seek permanent employment abroad. The aim of the study was to investigate the profile of South African qualified physicians who emigrated from South Africa. Methods: The investigation was conducted in 2005 as a descriptive study where the participants were primarily found by the snowball sampling method. The initial group of participants were known to the researcher. Participants had to be graduates from South African medical schools/faculties; living abroad and in possession of a permanent work permit in the countries where they were employed. Short-term locum doctors were not included. Information; consent letters and questionnaires were either hand-delivered or e-mailed; and completed forms and questionnaires were returned via these routes. Participation was voluntary. Results: Twenty nine of 43 potential participants responded; of which 79.3were male and 20.7female between the ages of 28 and 64 years (median 47 years). The year of graduation ranged from 1964 to 2000 (median 1985); and the year of leaving the country ranged from 1993 to 2005 (median 2002). The majority (72.4) were in private practice before they left; 27.5had public service appointments and 17.3were employed by private hospitals. Seventy nine percent of respondents had postgraduate qualifications. Countries to which migration occurred included New Zealand; United Arab Emirates; Bahrain; United Kingdom; Canada; Yemen; and Australia. Forty one percent of respondents indicated that they would encourage South African young people to study medicine; although 75would recommend newly graduate doctors to leave the country. Financial factors were indicated as a reason for leaving by 86.2of the respondents; better job opportunities by 79.3; and the high crime rate in South Africa by 75.9. Only 50of the respondents said that better schooling opportunities for their children played a role in their decision to leave the country. Approximately one-fifth (17.9) of the respondents indicated that they already had family abroad by the time they decided to emigrate. Conclusions: Financial reasons were the most important motivating factor in this particular group of doctors who relocated to overseas destinations; followed by working conditions and the rate of crime and violence in the country. In comparison to other investigations published previously; the results presented here clearly indicate a tendency that more doctors offer financial and crime-related reasons for migration from South Africa than before. In order to prevent the loss of medical expertise from a society already in need of quality healthcare; issues compelling doctors to look for greener pastures should be addressed urgently and aggressively by stakeholders

Clandestine Abortion in Port Harcourt: Users' Profile and Motivation

Background: Most of the information on abortion in Nigeria are based on information from women hospitalized for abortion complications. However a lot of abortions; especially those carried out by medical doctors do not cause enough complications to register in hospital statistics. This study is to explore the profile of women that obtain these relatively safe abortions; and to ascertain their reasons for opting for an abortion. Methods: A cross sectional study was carried out in five clinics located in various parts of Port Harcourt; Nigeria; known to provide abortion services. Data on all the women that sought abortion in the clinics between January and March 2007 were collected by the attending doctors. Results: A total of 793 women sought abortion in the clinics within the three months study period; a daily average of 1.76. The clients had an average age of 23.73 years (s.d 7.3); and a large proportion were not yet married (72.01); had no children (67.97); were still in school or learning a trade (66.08); and were having their first termination of pregnancy (68.22). Clients that identified themselves as widowed; divorced or separated made up 17.78of the total. The commonest reasons cited for the decision to terminate the pregnancy were that the women were not yet married (63.43); and that they were still students or learning a trade (60.15). Few women gave contraceptive failure (3.91) or the fact that they did not want any more children (3.66) as a reason for the abortion. Conclusions: Abortion on demand is still very common in Nigeria in spite of legal restrictions. Amending the abortion laws would assist in resolving this paradox

Development of Human Resources for Health in The WHO African Region: Current Situation and Way Forward

Human resources for health (HRH) are widely recognised as the most important assets and pillar of any health system. However the African Region is faced with severe shortages of this important human capacity. This has resulted in weak health systems with a limited capacity to achieve their national health goals. The problem is more severe in rural and remote areas where most people typically live in the countries in the African Region. This paper provides information about the efforts and commitments by Member States and the various opportunities created by Regional and global partners; including the progress made. The paper also explores issues and challenges related to the underlying factors of the HRH crisis; such as chronic underinvestment in health systems development in general; and specifically in human resources for health development; migration of skilled health personnel as a result of poor working conditions and remuneration; lack of evidence-based strategic planning; insufficient production of health workers and poor management systems

Motivation du patient : etape de taille pour un bon traitement parodontal (1ere partie)

Savoir traiter; c'est tout d'abord savoir motiver et pouvoir s'engager dans une relation de confiance avec le patient. Se faire respecter; gerer les conflits et amener le patient a maintenir une hygiene bucco-dentaire adequate exige quelques competences en matiere de communication et une connaissance suffisante en sciences comportementales. Le but de cet article est de montrer l'interet de reussir a motiver un patient et de passer en revue les differentes methodes permettant d'aboutir a des resultats predictibles et durables pour un traitement parodontal optimal

Assistance Needed for the Integration of Orphaned and Vulnerable Children: Views of South African Family and Community Members

Guardianship within families is often regarded as the most viable and preferred option for orphaned and vulnerable children (OVC). However; this will place a considerably increased burden on the new caregivers of these children. This study examines whether assistance to prospective families would incline them towards incorporating children and; if so; what would act as 'threshold' incentives for them. Adults (N = 1 400) in diverse locations and of various 'relational proximity' to children were interviewed in three high HIV/AIDS prevalence provinces in South Africa. Close relatives were more inclined to take in children and would generally require lower levels of assistance than more distanced adults. Nonetheless; for most poor families; no matter their relation to the child; help is critical. More distanced families; friends and strangers also showed a strong willingness to incorporate children - provided they receive sufficient help. For all categories; the greater the assistance the more likely they would be to take in children. While direct financial assistance was important; assistance with education-related costs and having a trained and caring person come in 'now and then' to help were also significant factors. The age and HIV status of the child were viewed as important intervening factors in deciding whether or not to take in an additional child/ren by some people