Barriers and solutions to effective mentorship in health research and training institutions in Nigeria: Mentors, mentees, and organizational perspectives.

Aims and Background: Mentoring relationships and programs have become a subject of global interest and their relevance is high in the ever-evolving health system. In Nigeria, informal system of mentoring is largely practiced. To be able to institutionalize mentoring program, there is need to explore the various challenges of mentoring process and suggest potential approaches for effective mentor-mentee relationship in health research institutions in Nigeria. Subjects and Methods: The study was designed to explore the barriers and solutions to mentoring process from the perspectives of the mentor, mentee, and organization in health research and training institutions in Nigeria. A cross-sectional descriptive design was employed and the study was conducted among 21 health researchers drawn from 24 health research institutions across the 6 regions of Nigeria. The nominal group technique was adopted in the data collection process. Results: The most frequently reported mentor challenges were "lack of understanding of mentorship process" (84.2%) and "lack of capacity for mentoring" (78.9%), while those of mentee were "mentor preference" (73.7%) and "lack of freedom of expression" (47.4%). "Culture of selfishness/individualism" (84.2%) and "lack of formal relationship" (63.2%) were the most mentioned systemic challenges. Training on mentoring process and relationship was mentioned as the most frequent approach to overcoming challenges for the three perspectives. Conclusion: Significant mentorship challenges exist in the Nigerian health, academic and research institution. Systematic approaches to finding and implementing the appropriate solutions are needed to circumvent these bottlenecks.

Evaluation of postgraduate educational environment in a Nigerian teaching hospital.

BACKGROUND: Congenial educational environment (EE) is paramount to effective impartation of knowledge as required in residency training. In this study EE for residency training is evaluated using Postgraduate Hospital Educational Environment Measure (PHEEM). OBJECTIVES: To assess the postgraduate educational environment at the University of Nigeria Teaching Hospital (UNTH), South-East Nigeria, using PHEEM and to determine if there are significant differences in PHEEM scores amongst various sub-groups of resident doctors. METHODS: A cross-sectional study, employing a census survey, involving the administration of validated PHEEM questionnaires to residents in the Departments of Internal Medicine, Obstetrics/Gynaecology, Pediatrics and Surgery in the year 2018. Data entry and analysis were done using SPSS. ANOVA assessed significance of total scores and sub-scale scores. Cronbach's alpha was calculated. RESULTS: A total of 114 Males and 46 females; 93 registrars and 67 senior registrars responded giving 71% response rate. Overall PHEEM score was 85.82; Role autonomy (29.27), Perception of teaching (34.80), Perception of social support (21.55). Males scored more than females in total PHEEM score (p = 0.000, F = 148.235), perception of teaching (P = 0.000, F = 420), and perception of social support (p = 0.000, F = 162.95), but not in role autonomy (p = 0.748, F = 0.104). Registrars scored more than senior registrars in total PHEEM (p = 0.000, F = 67.159), role autonomy (p = 0.000, F = 25.123), Perception of teaching (p = 0.000, F = 18.042) but not in perception of social support (p = 0.31, F = 1.045). There were significant differences in total and subscale scores amongst the specialties. Cronbach's alpha was 0.915. CONCLUSIONS: Postgraduate educational environment in UNTH has more positives than negatives but with room for improvement. There are significant differences in PHEEM scores among various groups of resident doctors.

Does preoperative chemical depilation make any difference in postoperative wound infection?

BACKGROUND: Preparation for surgery has traditionally included the removal of body hair from the intended surgical wound site. The effect of this practice on postoperative wound infection is yet to be fully elucidated. AIMS: This study sought to determine if preoperative chemical depilation reduces the risk of surgical site infection (SSI). METHODOLOGY: Two methods of preoperative hair removal: razor shaving and depilatory cream were compared. The eligible patients were randomized into two groups and the presence of postoperative wound infection was evaluated using the Southampton wound grading system. Data were analyzed using SPSS version 21 Chicago-Illinois, statistical significance was inferred at Pvalue ≤ 0.05. RESULTS: In total 100 patients were analyzed with 20 patients excluded due to co-morbidities and noncompletion of the study. The overall prevalence of SSI was 18.0% (7 (14.0%) and 11 (22.0%) in the depilatory cream and razor shaving groups, respectively). The difference in the rate of SSI was not statistically significant (P = 0.436). Hair was completely removed in 47 (94.0%) compared to 38 (76.0%) patients in the razor shaving group (P = 0.012) while skin injuries were noted in 21 (42.0%) vs 1 (2.0%) patients who had razor shaving and chemical depilation(P = <0.0001), respectively. CONCLUSION: There was no significant difference in SSI rates in patients that had preoperative chemical depilation when compared with razor shaving.

Drug pooling: A cost-saving strategy to enhance antibiotics availability for pediatric in-patient in Nigeria.

BACKGROUND: Antibiotic use is common but has a lot of challenges. Implementation of an efficient and cost-effective policy, which can improve the availability and sustainability of pediatric antibiotic use, is required. In this study, we explore the concept of antibiotic drug pooling (DP) as a means to overcome challenges often associated with antibiotic use. MATERIALS AND METHODS: The study was undertaken in three public tertiary hospitals in Southeast Nigeria using a mixed-methods approach. Three focus group discussions with caregivers of in-patient children and 16 in-depth interviews with physicians, nurses, and pharmacists provided the data for the study. In addition, the medical records of patients on admission were examined. Information collected centered mainly on antibiotic use and challenges, participants' perception of antibiotics pooling, as well as possible ways to improve on antibiotic availability and sustainability. RESULTS: Out of 53 children on admission, antibiotics were prescribed for 45 (84.2%) of them children. Seventeen (37.8%) of the 45 on antibiotics had their initial antibiotics changed. The major challenges encountered by all the caregivers interviewed were the cost of the antibiotics (85%). None of the caregivers was willing to submit their purchased drugs for pooled use by other in-patients. Health-care providers, however, lauded the concept of DP and made the following suggestions on ways the proposed concept could be improved: harmonized prescription, billing, and unit-dose dispensing for the first 72 h antibiotic treatment. CONCLUSION: The adoption of a harmonized prescription pattern and billing as well as unit-dose dispensing for the first 72 h antibiotic treatment will provide a cost-effective means of ensuring antibiotic availability and sustainability. The drug-pooling concept will not only enhance prompt commencement and discontinuation of antibiotic treatment but will also reduce waste and improve time-out policy.

An exploratory study of patients' perceptions of responsiveness of tertiary health-care services in Southeast Nigeria: A hospital-based cross-sectional study.

BACKGROUND: The achievement of universal health coverage in Nigeria requires evaluating the extent the expectation of those who have utilized health-care services are met. The study assessed the level of clients' perceived responsiveness of tertiary hospitals in the provision of specialist health-care services in Nigeria. METHODS: A hospital-based, cross-sectional study was conducted among adult patients and caregivers of children on admission in three tertiary health facilities in Southeast Nigeria. Data were collected from 137 respondents using a questionnaire that was adapted from the World Health Organization-structured responsiveness questionnaire. The key variables were on (a) respect for persons (dignity, confidentiality, and autonomy of individual) and (b) client orientation (prompt attention, access to social network during care, quality of basic amenities, and choice of provider), and data were analyzed using multivariate methods. RESULTS: The choice of care provider (80.0%) and autonomy (80.9%) were the lowest perceived responsiveness domains while prompt attention (89.2%) and dignity (87.7%) were rated highest by respondents. Multivariate analysis found significant association between gender and some responsiveness domains such as autonomy (P = 0.024), prompt attention (P = 0.003), and quality of basic amenities (P = 0.015) and between occupation and prompt attention (P = 0.034). CONCLUSIONS: Many critical aspects of specialist services in tertiary hospitals do not respond to clients' need while some do. It is important that poorly performing domains of services are strengthened, especially with upgrading the quality of basic infrastructure so as to improve the performance of the tertiary hospitals.

Health care financing in Nigeria: Implications for achieving universal health coverage.

The way a country finances its health care system is a critical determinant for reaching universal health coverage (UHC). This is so because it determines whether the health services that are available are affordable to those that need them. In Nigeria, the health sector is financed through different sources and mechanisms. The difference in the proportionate contribution from these stated sources determine the extent to which such health sector will go in achieving successful health care financing system. Unfortunately, in Nigeria, achieving the correct blend of these sources remains a challenge. This review draws on relevant literature to provide an overview and the state of health care financing in Nigeria, including policies in place to enhance healthcare financing. We searched PubMed, Medline, The Cochrane Library, Popline, Science Direct and WHO Library Database with search terms that included, but were not restricted to health care financing Nigeria, public health financing, financing health and financing policies. Further publications were identified from references cited in relevant articles and reports. We reviewed only papers published in English. No date restrictions were placed on searches. It notes that health care in Nigeria is financed through different sources including but not limited to tax revenue, out-of-pocket payments (OOPs), donor funding, and health insurance (social and community). In the face of achieving UHC, achieving successful health care financing system continues to be a challenge in Nigeria and concludes that to achieve universal coverage using health financing as the strategy, there is a dire need to review the system of financing health and ensure that resources are used more efficiently while at the same time removing financial barriers to access by shifting focus from OOPs to other hidden resources. There is also need to give presidential assent to the national health bill and its prompt implementation when signed into law.

Caregivers' willingness-to-pay for a topical anesthetic cream for minor medical procedures in children.

BACKGROUND: Topical anesthetic cream (TAC) is not in use in pediatric practice in Sub-saharan regions. Knowledge of Caregivers' willingness-to-pay (WTP) for the cream is necessary for its deployment. OBJECTIVE: To determine the WTP for TAC for minor pediatric painful procedures. MATERIALS AND METHODS: The study was a questionnaire-based conducted in two tertiary health institutions in southeast Nigeria. WTP was elicited using the contingent valuation method. The respondents were caregivers to children that attended out-patient clinics and in-patient. Data analysis was by Statistical Package for the Social Sciences software (SPSS) and STATA11. RESULTS: Majority (94%) of the respondents were willing to pay for TAC. The mean maximum WTP was US$8.31. Multivariate analysis showed no statistically significant association between many variables with WTP for TAC. CONCLUSIONS: Their average WTP was higher than the market price of topical anesthetic cream. Therefore, there is a good prospect for TAC if deployed in Nigeria.

Malaria diagnosis and treatment amongst health workers in University of Nigeria Teaching Hospital, Enugu, Nigeria.

BACKGROUND: Confirmation of malaria and appropriate treatment are keys to malaria control. OBJECTIVE: To determine the practice of malaria diagnosis and treatment in a Nigerian tertiary hospital. MATERIALS AND METHODS: Retrospective review of patients' records at the Children's Clinic in UNTH. RESULTS: Out of 6,684 children seen within the one year reviewed period, children diagnosed with malaria were 35.8 percent. Males were 60 percent and females were 40 percent. Children under five years were 72.6 percent of the total. Folders successfully traced were 1012; in 92 percent investigations for malaria were requested while 32 percent had differential diagnosis. Out of the 931 malaria investigations requested, 30 percent did the tests and positive results were 94.9 percent. Presumptive treatment was 98 percent. Majority (83.3%) received ACTs. CONCLUSION: The practice of presumptive treatment was high and few cases had a differential diagnosis. Training of health workers on the need to confirm malaria cases is required.

AUDIT OF BLOOD TRANSFUSION PRACTICES IN THE PAEDIATRIC MEDICAL WARD OF A TERTIARY HOSPITAL IN SOUTHEAST NIGERIA.

OBJECTIVES: To determine the indications, practices and outcomes of transfusion on children. DESIGN: A descriptive retrospective study. SETTING: Paediatric wards of University of Nigeria Teaching Hospital, Enugu, Nigeria. SUBJECTS: Children one month to 18 years that received blood transfusion. MAIN OUTCOME MEASURES: Indications for the transfusion, haemoglobin rise, vital signs, duration of transfusion and adverse events. RESULTS: The two hundred and thirty eight transfusions reviewed were given amongst 95 patients, at a ratio of 2.5 transfusions per patient. The indicators of the transfusion were: malignancy (31.7%), sepsis (15.1%), sickle cell anaemia (12.1%), malaria (10.0%), hyperbilirubinaemia (10.0%), HIV/AIDS (8.3%), nephrotic syndrome (7.2%) and malnutrition (5.4%). Whole blood (56.4%) and sedimented cells (36.3%) were the main types of blood transfused. About 96.4% were transfused appropriate volume of blood. The mean Haemoglobin concentration (Hb) increase was 3.1g/dl and 12.8% of the recipients recorded an Hb increase of 5g/dl. The mean duration of transfusion was 4.6 hours and 59.7% of the transfusions exceeded the recommended four hours. Pulse and respiratory rates returned to normal post transfusion in 26.1 and 21.8% of the recipients respectively. In 10% of the transfusions there were minor adverse events; chills/fever (5.1%), itching (3.4%), hypothermia (1.0%) and vomiting (0.5%). CONCLUSION: Blood transfusion in this tertiary institution is not common and mainly due to non-communicable diseases. The expected optimal rise in Hb and normalising of vitals sign are not always the case. The duration of most transfusions was unduly prolonged and transfusion-related adverse events are rare.