Effectiveness of Self-directed Virtual Learning on Retention of Cardiopulmonary Resuscitation Knowledge and Skills among Hospital Nurses in North-western Nigeria: Protocol Paper

@#Introduction: The instructor-led CPR training method has been used for over 4 decades. However, nurses’ knowledge and skills are still low. Instructor-led CPR training is an extremely capital-intensive programme that requires more time, workforce, and space, thus serving as an impediment to effective learning among the prospective nurses’ trainees. Self-directed training method is suggested to improve the knowledge and skills of CPR among healthcare practitioners due to the low cost and flexibility. This study aims to evaluate the effectiveness of self-directed method in improving nurses’ knowledge and skill retention from baseline to post-test, one, three-, and six months. Method: A two-arm double-blinded randomised controlled trial will be conducted in two referral hospitals. The control group training consists of a one-day session taught by AHA-certified instructors, whereas the intervention group training entails participants learning on computers in a simulation lab for seven days. A generalised estimated equation model will be used for statistical analysis. Discussion: Through the self-directed training method, participants will have significantly better knowledge and skills of CPR compared to the conversational training method across the time points. Self-directed training method is a simple, cost-effective and flexible method, which can facilitate the training of more nurses in the acquisition and retention of knowledge and skills, especially for those who prefer to learn at their own pace. Trial Registration: Registration Code: UDUTH/NHREC/30/012/2019 and NHREC/28/01/2020/AKTH/EC/2934

Relationship between Sinonasal Anatomical Variations and Symptom Severity in Patients with Chronic Rhinosinusitis.

Background: Anatomical variations are subtle structural abnormalities around the osteomeatal complex that might obstruct paranasal sinus drainage and ventilation. The role of these anatomical variants in chronic rhinosinusitis is still controversial and unclear. The aim of this study was to determine the prevalence of anatomical variations and their relationship with the severity of symptoms in patients with chronic rhinosinusitis. Materials and Methods: This was a cross-sectional study conducted among randomly selected patients with chronic rhinosinusitis. Sinonasal Outcome Test-20 (SNOT-20) was used to assess the patient's severity of symptoms. Computed tomographic scan was used to determine the presence of anatomical variations. The relationship between anatomical variations and symptom severity was determined using the Statistical Products and Service Solution (SPSS) version 20.0. Results: There were 70(58.3%) males and 50(41.7%) females within the age range of 17-60 years. SNOT-20 scoring showed 6(5.0%) of the patients with mild symptoms, 69(57.5%) with moderate, 37(30.8%) with severe, and 8(6.7%) with profound symptoms. The prevalence of sinonasal anatomical variants was 26.7%, which comprised of septal deviation (10.8%), agger nasi (6.7%), concha bullosa (4.2%), Haller cells (3.3%), and Onodi cells (1.7%). There was a statistically significant relationship between the anatomical variations and symptom severity (P = 0.000). Conclusion: This study found a significant relationship between anatomical variations and severity of chronic rhinosinusitis. The prevalence of anatomical variants was found to be 26.7%.

Contexte: Les variations anatomiques sont des anomalies structurelles subtiles autour du complexe ostéoméatal qui peuvent obstruer le drainage et la ventilation des sinus paranasaux. Le rôle de ces variantes anatomiques dans la rhinosinusite chronique est encore controversé et peu clair. Le but de cette étude était de déterminer la prévalence des variations anatomiques et leur relation avec la sévérité des symptômes chez les patients atteints de rhinosinusite chronique. Méthodologie: Il s'agissait d'une étude transversale menée auprès de patients sélectionnés au hasard et atteints de rhinosinusite chronique. Sinonasal Outcome Test-20 (SNOT-20) a été utilisé pour évaluer la gravité des symptômes du patient. La tomodensitométrie a été utilisée pour déterminer la présence de variations anatomiques. La relation entre les variations anatomiques et la gravité des symptômes a été déterminée à l'aide de la version 20 de la solution SPSS. Résultats: Il y avait 70 (58,3%) hommes et 50 (41,7%) femmes dans la tranche d'âge de 17 à 60 ans. Le score SNOT-20 a montré que 6 (5,0%) des patients présentaient des symptômes légers, 69 (57,5%) des symptômes modérés, 37 (30,8%) des symptômes graves et 8 (6,7%) des symptômes profonds. La prévalence des variantes anatomiques naso-sinusiennes était de 26,7%, comprenant la déviation septale (10,8%), l'agger nasi (6,7%), la concha bullosa (4,2%), les cellules de Haller (3,3%) et les cellules d'Onodi (1,7%). Il y avait une relation statistiquement significative entre les variations anatomiques et la sévérité des symptômes (P = 0,000). Conclusion: Cette étude a trouvé une relation significative entre les variations anatomiques et la sévérité de la rhinosinusite chronique. La prévalence des variantes anatomiques était de 26,7%.

Mammographic screening patterns in Sokoto, Northwestern Nigeria

Background: Screening mammography is a radiographic examination of the breast performed for early detection of breast cancer in asymptomatic women. The American College of Radiology recommends that women should have mammography at the age of 40 years and annually thereafter. However, those who are at increased risk of breast cancer should start screening mammography earlier. These include patients with a strong family history of breast cancer or those who had radiotherapy to the chest wall.Objective: This study is aimed at evaluating the mammographic outcomes among 77 Nigerian females who had screening mammographic breast examination. Materials and Methods: From December 2010 and November 2012, 77 females had routine screening mammography in the department with the general electric alpha­RT machine with model number MGF­101 (manufactured 2010). All the participants had to fill a mammographic form consisting of variables such as age, sex, occupation, family history ofbreast cancer, tribe, contraception, parity and caffeine consumption, history of surgical intervention (lumpectomy, biopsy, and/or mastectomy), previous mammography, and last childbirth. Mediolateral­oblique and cranial­caudal views were done for the breast examination though additional were occasionally employed. Results: Seventy­seven females had screening mammography. The minimum age recruited was 40 years. The mammographic outcome for those who had screening was normal in 51 (66.2%) and abnormal in 26 (33.8%) participants. The abnormal mammographic outcomes were architectural distortion in either or both breasts in 13 (16.9%) participants, masses in either or both breast in 11 (14.3%) participants, while isolated calcification in either or both breast among 2 (2.6%) participants. Two (18.2%) of the subjects with masses had associated macrocalcification. No masses with malignant features were seen. Conclusion: Screening mammography was found out to be useful in detecting various forms of breast pathologies which were mostly breast masses, calcifications, and architectural distortions. Screening mammography is, therefore,advised yearly and routinely for women age 40 years and above

Notifiable disease reporting among public sector physicians in Nigeria: a cross-sectional survey to evaluate possible barriers and identify best sources of information.

BACKGROUND: Since 2001, Nigeria has collected information on epidemic-prone and other diseases of public health importance through the Integrated Disease Surveillance and Response system (IDSR). Currently 23 diseases are designated as "notifiable" through IDSR, including human infection with avian influenza (AI). Following an outbreak of highly pathogenic avian influenza A(H5N1) in Nigerian poultry populations in 2006 and one laboratory confirmed human infection in 2007, a study was carried out to describe knowledge, perceptions, and practices related to infectious disease reporting through the IDSR system, physicians' preferred sources of heath information, and knowledge of AI infection in humans among public sector physicians in Nigeria. METHODS: During November to December 2008, 245 physicians in six Nigerian cities were surveyed through in-person interviews. Survey components included reporting practices for avian influenza and other notifiable diseases, perceived obstacles to disease reporting, methods for obtaining health-related information, and knowledge of avian influenza among participating physicians. RESULTS: All 245 respondents reported that they had heard of AI and that humans could become infected with AI. Two-thirds (163/245) had reported a notifiable disease. The most common perceived obstacles to reporting were lack of infrastructure/logistics or reporting system (76/245, 31%), lack of knowledge among doctors about how to report or to whom to report (64/245, 26%), and that doctors should report certain infectious diseases (60/245, 24%). Almost all participating physicians (>99%) reported having a cell phone that they currently use, and 86% reported using the internet at least weekly. CONCLUSIONS: Although the majority of physicians surveyed were knowledgeable of and had reported notifiable diseases, they identified many perceived obstacles to reporting. In order to effectively identify human AI cases and other infectious diseases through IDSR, reporting system requirements need to be clearly communicated to participating physicians, and perceived obstacles, such as lack of infrastructure, need to be addressed. Future improvements to the reporting system should account for increased utilization of the internet, as well as cell phone and email-based communication.

HIV counseling and testing and access-to-care needs of populations most-at-risk for HIV in Nigeria.

Mobile HIV counseling and testing (mHCT) is an effective tool to access hard-to-reach most-at-risk populations (MARPs), but identifying which populations are not accessing services is often a challenge. We compared correlates of human immunodeficiency virus (HIV) infection and awareness of HIV care services among populations tested through mHCT and at testing facilities in Nigeria. Participants in a cross-sectional study completed a questionnaire and HCT between May 2005 and March 2010. Of 27,586 total participants, 26.7% had been previously tested for HIV; among mHCT clients, 14.7% had previously been tested. HIV prevalence ranged from 6.6% among those tested through a facility to 50.4% among brothel-based sex workers tested by mHCT. Among mHCT participants aged 18-24, women were nine times more likely to be infected than men. Women aged 18-24 were also less likely than their male counterparts to know that there were medicines available to treat HIV (63.2 vs. 68.1%; p=0.03). After controlling for gender, age, and other risk factors, those with current genital ulcer disease were more likely to be HIV-infected (OR(mHCT)=1.65, 1.31-2.09; OR(facility)=1.71, 1.37-2.14), while those previously tested were less likely to be HIV-infected (OR(mHCT)=0.75, 0.64-0.88; OR(facility)=0.27, 0.24-0.31). There is an urgent need to promote strategies to identify those who are HIV-infected within MARPs, particularly young women, and to educate and inform them about availability of HIV testing and care services. mHCT, ideally coupled with sexually transmitted infection management, may help to ensure that MARPs access HIV prevention support, and if infected, access care, and treatment.

Lack of evidence of avian-to-human transmission of avian influenza A (H5N1) virus among poultry workers, Kano, Nigeria, 2006.

BACKGROUND: In February 2006, poultry outbreaks of highly pathogenic avian influenza A (H5N1) virus were confirmed in Nigeria. A serosurvey was conducted to assess H5N1 transmission among poultry workers and laboratory workers in Nigeria. METHODS: From 21 March through 3 April 2006, 295 poultry workers and 25 laboratory workers with suspected exposure to H5N1 virus were administered a questionnaire to assess H5N1 exposures, medical history, and health care utilization. A serum specimen was collected from participants to test for H5N1 neutralizing antibodies by microneutralization assay. RESULTS: The 295 poultry workers reported a median of 14 days of exposure to suspected or confirmed H5N1-infected poultry without antiviral chemoprophylaxis and with minimal personal protective equipment. Among 25 laboratory workers, all handled poultry specimens with suspected H5N1 virus infection. All participants tested negative for H5N1 neutralizing antibodies. CONCLUSIONS: Despite widespread exposure to poultry likely infected with H5N1 virus, no serological evidence of H5N1 virus infection was identified among participants. Continued surveillance for H5N1 cases in humans and further seroprevalence investigations are needed to assess the risk of avian-to-human transmission, given that H5N1 viruses continue to circulate and evolve among poultry.