An Evaluation of Push and Pull Factors associated with the Emigration of Medical Consultants from Nigeria.

Background: The health workforce of a nation is crucial to its economic productivity and development. In Nigeria, the emigration of healthcare professionals from the country has become alarming and is fueled by various factors. This study thus determined to study the push and pull factors encouraging the emigration of medical consultants from Nigeria as well as their perceptions of what can be done to retain Nigeria's health workforce in the country. Methodology: An online survey of 238 consultants (fellows) of the West Africa College of Physicians, West Africa College of Surgeons, and the National Postgraduate Medical College of Nigeria under the auspices of the Medical and Dental Consultants Association of Nigeria (MDCAN) was conducted. A structured questionnaire was used as the instrument for data collection. The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 23. Results: Push factors promoting the emigration of doctors identified in this study included the occurrence of armed conflict (66.0%), the inadequacy of job opportunities (69.7%), poor remuneration (69.7%) as well as the need to improve professional skills (82.4%). Pull factors supporting the emigration of the doctors included the need for better prospects for their professional practice (65.1%) and their children (84.9%), better remuneration (87.4%), and the assurance of better security (76.1%). Availability of incentives (82.4%), as well as improved security (85.3%) among other factors, were identified as being effective in retaining Nigeria's health workforce. Conclusion: The problem of doctors' emigration from Nigeria persists and is fueled by various factors that need to be addressed urgently for improving the retention of the country's health workforce. It is recommended that a holistic approach confronting issues of training, availability of an enabling environment as well as the professional progression of doctors be adopted in tackling this emigration problem.

A Study of Childhood Malaria trends at the University of Port Harcourt Teaching Hospital: 2006 - 2018.

Background: Several efforts have been put in place to reduce the global burden of malaria especially in children and in sub-Saharan Africa. The study aimed to evaluate the impact of malaria control activities on the trend of childhood malarial diseases at a tertiary hospital in South-south Nigeria. Methodology: A retrospective review of the case records of all malaria diagnoses including in-patient, out-patient, and emergency room, seen in the Department of paediatrics at the University of Port Harcourt Teaching Hospital from January 2006 to December 2018 was conducted. Results: There were 41, 863 malaria cases diagnosed over the 12 years with a decline in yearly diagnosis and admissions, from the year 2006 through 2018. Total malaria admissions were 578, (44.5/ year), giving a severe malaria incidence of 1.26%, and there were 164 malaria death cases, with a yearly average of 12. The causes of death in the children with malarial parasitaemia were severe anaemia in 75 (45.7%), hypoglycaemia in 14 (8.5%), cerebral malaria in 17 (10.4%), and prostration with other co-morbidities, 22 (13.4%). Thirty-six children (22%) were convulsing and died soon after admission, with a compounding diagnosis of aspiration and respiratory failure. Conclusion: There is a gradual reduction in childhood malaria disease, admission, and death, though this is slower than anticipated based on efforts and strategies put in place by the Nigerian government and various organizations.

Microalbuminuria in type 1 diabetes mellitus children in University of Port Harcourt Teaching Hospital, Nigeria.

INTRODUCTION: glycaemic control is usually best achieved using the basal bolus regimen, however, this is not always available in resource-limited settings. Long-term complications like renal parenchymal disease are consequences of poor glycaemic control. Screening type 1 diabetes patients irrespective of their disease duration was used to buttress the need for ethical principles of justice to be incorporated in the care of type 1 diabetes children. METHODS: urine albumin creatinine ratio (UAC) was calculated for 20 type 1 diabetes mellitus children in the endocrinology clinic after submitting early morning urine over a 4-month period. The calculated ratio was compared between duration of disease (< 5 years and > 5 years) and between insulin regimen types (mixtard and basal bolus). Repeat tests were done for children who had elevated UAC ratio levels after 2 months. RESULTS: there were 5 males and 15 females and the mean UAC ratio of the cohort was 123mg/g with a range of 5.30 - 906 mg/g. Twelve children (8 diagnosed less than 5 years) had UAC ratio ≥ 30mg/g with a mean of 193.15. The repeat mean UAC ratio for these was 144.35 mg/g. Children who had diabetes for more than 5 years and were on mixtard had higher UAC ratio than those with diabetes < 5 years and on basal bolus. CONCLUSION: the prevalence of microalbuminuria is high in our cohort of type 1 diabetes children and these were children on mixtard and had diabetes greater than 5 years.

Newborn screening in Nigeria: Associating the screening of congenital hypothyroidism and sickle cell disease can be a winning choice?

ntroduction: Nigeria like many African countries has tried to start the newborn screening for congenital hypothyroidism and many failed. Since sickle cell disease is more common in Nigeria, the hypothesis is that incorporating it into a screening programme for congenital hypothyroidism will improve the uptake of the programme by parents and government. METHODS: Different aspects of newborn screening with difficulties and challenges in running newborn screening were identified and discussed. RESULT: Identifying that for newborn screening to be successful, several key factors have to be put in place including but not limited to organizational structure, system thinking, finance, legislative and political will. A proper recall system for test positives and diagnostic/confirmatory test must be put in place before the programme starts. Since several other screening programmes like sickle cell disease, cervical and breast cancer have run successfully in Nigeria, incorporating one of them into the newborn screening for CH can make the programme succeed as there will be better uptake by the population and the policy makers. CONCLUSION: The difficulty in establishing a newborn screening programme in Nigeria stem from health care financing, organizing the programme from screening through to recall and treatment, and ultimately, prevention of diseases.