Constraints; Challenges and Prospects of Public-Private Partnership in Health-Care Delivery in a Developing Economy

Background: In Nigeria; concerns on the quality and financing of health-care delivery especially in the public sector have initiated reforms including support for public-private partnerships (PPP) at the Federal Ministry of Health. Likewise; Enugu State has developed a draft policy on PPP since 2005. However; non-validation and non-implementation of this policy might have led to loss of interest in the partnership. Aim: The aim of this study was to provide evidence for planning the implementation of PPP in Enugu State health system via a multi-sectoral identification of challenges; constraints and prospects. Subjects and Methods: Pre-tested questionnaires were administered to 466 respondents (251 health workers and 215 community members); selected by multi-stage sampling method from nine Local Government Areas of Enugu State; Nigeria; over a study period of April 2011 to September 2011. Data from the questionnaires were collated manually and quantitative data analyzed using SPSS version 15 (Chicago; IL; USA). Results: Only 159 (34.1; 159/466) of all respondents actually understood the meaning of PPP though 251 (53.9) of them had claimed knowledge of the concept. This actual understanding was higher among health workers (57.8; 145/251) when compared with the community members (6.5; 14/215) (P 0.001). Post-PPP enlightenment reviews showed a more desire for PPP implementation among private health-care workers (89.4; 101/113) and community leaders/members (55.4; 119/215). Conclusion: PPP in health-care delivery in Enugu State is feasible with massive awareness; elaborate stakeholder's engagements and well-structured policy before implementation. A critical challenge will be to convince the public sector workers who are the anticipated partners to accept and support private sector participation

Leukocyte profile of adult Nigerian subjects with acute musculoskeletal trauma.

BACKGROUND: Leukocyte levels are evidently useful in trauma assessment, prognostication and management. Leukocytosis is a known physiologic response to trauma but suggested to be absent among Africans origin. The aim of present study is to investigate the existence of leukocytosis among adult Nigerians who sustain acute musculoskeletal trauma, S and also assess its prognostic value in management. METHODS: A calculated sample size of 223 subjects participated following informed consent while 50 apparently healthy adult Nigerian volunteers served as control. Data obtained included age, sex, duration of hospitalization and leukocyte counts using improved Neuabauer chamber while differential count was done on stained thin film. RESULTS: Analyzed results expressed as mean +/- SDM show significant male dominance (p < 0.05) among the acutely traumatized subjects with majority (70%) aged between 20 and 49 years. The mean total white blood cell count was 8184.96 +/- 201.087 cells/m3, significantly higher than mean for the control group (4922.00 + 1282.264 cells/mm3) at p < 0.05. The mean values for neutrophil and lymphocytes also show significant neutrophilia and lymphocytopaenia among the test population (p < 0.05). Pearson's correlation test for duration of hospitalization was positive for higher levels of total White Blood Cell count, with strong positive correlation between the levels of neutrophil and total White Blood Cell count suggesting the source of the observed leukocytosis. CONCLUSION: Thus adult Nigerians exhibit posttraumatic neutrophilic leukocytosis contrary to some widely accepted postulations. The post-traumatic neutrophilia exhibit an inverse relationship with observed lymphocytopaenia. This can be expressed as a ratio called Neutrophil Lymphocyte Stress Factor (NLSF) and used in trauma management and prognosis determination.

Surgical Resident Doctor's Perspective of their Training in the Southeast Region of Nigeria

There are several problems militating against satisfactory residency training in Nigeria. These problems may not be effectively identified and resolved if the opinion of the trainee doctors is ignored. Objectives: To review surgical residents' perspectives of their training program in South-eastern Nigeria; with the aim of suggesting evidence-based innovative changes to enable the programs meet global trends and standards. Materials and Methods: A total of 90 semi-structured and pre-tested questionnaires were evenly distributed (30 per hospital) to the surgical residents at three tertiary healthcare facilities in South-eastern Nigeria. Information sought included sociodemographic variables; level in the residency training; rating of program and different aspects; learning environments/opportunities; and suggestions on ways to improve either part or overall program. Results: Analysis of 56 properly completed questionnaires (response rate=62.2) shows that the respondents were aged 29 to 53 years [mean(SD) = 35.3(1.7)]; mostly males (91.1) and junior residents (75). A significant majority of residents (47 or 83.8) rated the surgical residency training in their respective centers as inadequate. Grand rounds were roundly criticized as having misplaced objectives and tending toward fault-finding by Consultants. Suggested interventions for improvement included enhanced supervision/mentoring/teaching by senior colleagues; inclusion of didactic lecture sessions; research trainings; and foreign postings. Conclusion: There exist gaps between expectations of surgical residents and the training offered. These create needed support for an evidenced-based review of surgical residency training program to enable it meet the aspirations of trainees and the ever-changing trend in Medicine. More studies on surgical residents covering other regions of Nigeria; and including the trainers (Consultants); will be of immense value

Medical students' evaluation of physiology learning environments in two Nigerian medical schools.

The expansion of biomedical knowledge and the pursuit of more meaningful learning have led to world-wide evidence-based innovative changes in medical education and curricula. The recent emphasis on problem-based learning (PBL) and student-centred learning environments are, however, not being implemented in Nigerian medical schools. Traditional didactic lectures thus predominate, and learning is further constrained by funding gaps, poor infrastructure, and increasing class sizes. We reviewed medical students' perceptions of their exposed learning environment to determine preferences, shortcomings, and prescriptions for improvements. The results confirm declining interest in didactic lectures and practical sessions with preferences for peer-tutored discussion classes, which were considered more interactive and interesting. This study recommends more emphasis on student-centered learning with alternatives to passive lecture formats and repetitive cookbook practical sessions. The institutionalization of student feedback processes in Nigerian medical schools is also highly recommended.

The Effect of Free Distribution of Insecticide-Treated Nets on Asymptomatic Plasmodium Parasitemia in Pregnant and Nursing Mothers in a Rural Nigerian Community

Introduction: Malaria is a major public health problem in Nigeria; with adverse outcomes on the poor; pregnant women and children living in rural communities. A major component of current intervention in roll back malaria (RBM) initiative is vector control and insecticide-treated nets (ITNs). Aims and Objective: This research studied the impact of free distribution of ITNs on malaria parasitemia in a rural community in Nigeria. Materials and Methods: This is a longitudinal survey involving 990 pregnant and nursing mothers who received free ITNs between February 2007 and September 2008. Blood samples were collected at contact; then every 2 months to check for malaria parasites using standard methods. Result: There was a sustained but insignificant rise in asymptomatic malaria parasitemia post-distribution of ITNs. Conclusion: We conclude that ITN intervention remains important in malaria prophylaxis but must be complemented with awareness campaigns and other vector control strategies

The Effect of Free Distribution of Insecticide-Treated Nets on Asymptomatic Plasmodium Parasitemia in Pregnant and Nursing Mothers in a Rural Nigerian Community

Introduction: Malaria is a major public health problem in Nigeria; with adverse outcomes on the poor; pregnant women and children living in rural communities. A major component of current intervention in roll back malaria (RBM) initiative is vector control and insecticide-treated nets (ITNs). Aims and Objective: This research studied the impact of free distribution of ITNs on malaria parasitemia in a rural community in Nigeria. Materials and Methods: This is a longitudinal survey involving 990 pregnant and nursing mothers who received free ITNs between February 2007 and September 2008. Blood samples were collected at contact; then every 2 months to check for malaria parasites using standard methods. Result: There was a sustained but insignificant rise in asymptomatic malaria parasitemia post-distribution of ITNs. Conclusion: We conclude that ITN intervention remains important in malaria prophylaxis but must be complemented with awareness campaigns and other vector control strategies

The effect of potassium bromate on some haematological parameters of Wistar rats.

Potassium bromate used widely in foods has been associated with various complications in humans. However there is paucity of literature on adverse effects on haematological parameters. Thus we decided to carry out an experimental study to determine the effects of potassium bromate on some blood indices using Wistar rats. Twenty (20) male Wistar rats aged 2-3 months obtained from the department of Veterinary Medicine, University of Nigeria Nsukka were acclimatized for two weeks. They were divided into five groups and fed with graded doses of potassium bromate solution for six weeks. One of the groups served as the control. Pre and post administration blood samples were collected and analyzed the same day using standard methods. The results revealed significant [P<0.05] decrease in the platelet count when compared with the controls. There were no statistically significant differences in the mean cell haemoglobin concentration, haematocrit, and total leukocyte counts between the test and control rats. Potassium bromate is injurious to health if consumed continuously and in high quantity. It has been shown to reduce platelet count in rats, and thus may cause thrombocytopenia in humans. It is therefore imperative to take adequate measures to eliminate the use of potassium bromate in the preparation of food products.

Comparative evaluation of active learning and the traditional lectures in physiology: a case study of 200 level medical laboratory students of Imo State Unversity, Owerri.

Currently, understanding of physiology and disease patterns is undergoing a fundamental paradigm shift with attendant shift in education of health professionals worldwide towards active learning to encourage exploration of connections and their relationships. We introduced problem-based learning to physiology teaching of medial laboratory students to confirm worldwide reports that active learning environments offer better learning opportunities over the traditional methods which is the predominant teaching method in Nigerian universities. Our findings indicate that problem-based learning increases students' attendance/participation in classes and performance in examination. We recommend the integration of active learning into physiology curriculum of Nigerian Universities.