The future of trauma care in a developing country: interest of medical students and interns in surgery and surgical specialties.

BACKGROUND: Attracting the best medical graduates to trauma-related specialties is pivotal for excellent injury management in future, especially with the rising global incidence of injuries. We sought to explore the interest of Nigerian medical students and interns in Orthopaedics, Cardiothoracic, Neurological, Burns and Plastic and General Surgery specialties. METHODS: A cross-sectional study was conducted using a self-administered questionnaire to assess interest in selected trauma-related specialties among 177 senior medical students and interns at the Lagos State University Teaching Hospital and Lagos University Teaching Hospital in Lagos, Nigeria. Stratified random sampling method was employed and Chi-square test was performed in data analysis using SPSS v15.0 statistical package. RESULTS: Majority (80%) showed interest in post-graduate specialization. Surgery topped the list of specialties chosen by participants while 55% were likely to choose one of the selected trauma-related specialties. Exposure to positive role models, male gender and being single were significantly associated with interest in trauma-related future career. Opportunities for career fulfilment, carrying out difficult procedures, research and discovery, intellectual challenges during practice, use of modern technology, financial remuneration of specialists, patient outcomes and previous theatre experience had significant positive influence on participants who had strong interest in trauma-related specialty. Lifestyle issues like workload, call schedules, stress and duration of residency, training conditions and facilities and time commitment to practice had negative influence on choice of specialty. CONCLUSION: Interest of medical students and interns in trauma-related specialties may be sustained and enhanced by practicing surgeons through mentoring and by serving as role models. Training programs in surgery should be revisited and made less stressful while lifestyle issues need to be made more favourable.

Socio-demographic determinants of stigma among patients with pulmonary tuberculosis in Lagos, Nigeria.

BACKGROUND: Patients living with tuberculosis (TB) experience significant disruption of their social life and are exposed to stigma and discrimination. This situation impacts on treatment adherence by individual patients and on disease control especially in developing nations. Different aetiological propositions have been propounded, including the relationship of tuberculosis with the Acquired Immune Deficiency Syndrome (AIDS). OBJECTIVES: We sought to evaluate self-reported stigma experience among TB patients in Lagos and examine its socio-demographic determinants. METHOD: This was a descriptive cross-sectional study, recruiting 205 patients on treatment at two government-owned referral centres for tuberculosis, using self-administered questionnaires to collect each respondent's data. RESULT: Eighteen percent reported a previous stigma experience. Stigma experience was observed to be significantly determined by age, low socio-economic status, level of education below secondary level, disclosure of status, history of weight loss, previous smoking and alcohol history. Also, patients unable to work on clinic days were more likely to experience stigma. Sex, religion, marital status and ethnicity were not significant determinants. CONCLUSION: Experience of stigma among patients with tuberculosis is common and may adversely affect treatment adherence. Healthcare workers and policy makers need to pay closer attention to the identified determinants for effective tuberculosis control.