Pre-service medical education course completion and drop-out rates.

INTRODUCTION: The "Global strategy on human resources for health: Workforce 2030" was adopted by the 69th World Health Assembly. Among its objectives is the strengthening of data on human resources for health, to inform evidence-based policy decisions. These data include the course completion and drop-out rates, to inform mechanisms that support recruitment and retention. OBJECTIVE: This paper sought to evaluate trends in course completion and drop-out rates of health workforce students. However, original data were only obtained for pre-service medical students, but no other health worker occupational groups. METHODS: A mixed method approach was employed to obtain data presented in this paper. A structured questionnaire was sent out to targeted medical training institutions, regulatory bodies, and National Medical Associations, supplemented by a web and literature search for existing studies or data reports. Data were analyzed using IBM SPSS Statistics version 21.0 (Chicago, IL, USA) and Microsoft Excel 2010. RESULTS: Eight previously published studies were identified originating from six countries, with course completion rates ranging from 84% in Pakistan to 98.6% in the United States of America, while the drop-out rates ranged from 1.4% in the United States of America to 16% in Pakistan. An analysis of pre-service medical students in Australia and New Zealand, revealed average course completion rates of 93.3% and 96.9%, respectively, and average drop-out rates of 6.7% and 3.1%, respectively. An analysis of pre-service medical students from Nigeria, revealed an average course completion rate of 88.3%, and an average drop-out rate of 11.7%. Data were not readily available for most countries targeted during the research, either because of lack of existing mechanisms for collation of required data or restrictions making such data publicly unavailable and inaccessible. CONCLUSIONS: Drop-out rate for pre-service medical students varies across countries with some countries recording higher drop-out rates, which raise significant concerns about the capacity of such countries to scale up production of human resources for health. Data that monitor both course completion and drop-out rates, and seek to provide insight into reasons for observed numbers, can inform mechanisms to address the causes of course drop-out and support student retention.

The future of global health is inclusive and anti-racist.

In global health, a discipline with a racist and colonial history, white supremacy, white privilege and racism are still present today.1 Although many believe we are witnessing a resurgence of racism in global health, because of a recent rise of extreme right comments and racism in the community and online2, 3. In reality racism has always been an inherent aspect of global health and its predecessors: tropical health and international health by prioritizing the health issues of the colonizers over those of the native populations.4 As such, we are rather bearing witness to long standing issues that have been persistently overlooked. There is a need for a paradigm shift to enable true authentic leadership that promotes the values of our shared humanity.

The risk perception of COVID-19 and practice of precautionary measures amongst healthcare workers in the National Health Insurance Scheme Clinic of a tertiary hospital in Nigeria.

INTRODUCTION: the novel coronavirus (SARS-CoV-2), the causative virus for coronavirus disease 2019 (COVID-19), was identified following the report of a cluster of cases of viral (atypical) pneumonia in Wuhan City of China. Healthcare workers are at high risk of contracting the infection from COVID-19 patients and also spreading it unknowingly to their families, especially if they do not take adequate precautionary measures. This study assessed the risk perception of COVID-19 and practice of precautionary measures against its spread amongst healthcare workers practicing in the National Health Insurance Scheme (NHIS) Clinic of a tertiary hospital in Nigeria. METHODS: this was a descriptive cross-sectional study conducted amongst healthcare workers in the National Health Insurance Scheme (NHIS) Clinic of a tertiary hospital in Nigeria. It employed the use of a pre-tested semi-structured questionnaire to obtain data from the participants. Data analysis was done using the IBM SPSS statistics version 22.0 (Chicago, IL, USA) statistical software. RESULTS: there were 49 study participants with all of them aware of COVID-19. Only 11(22.4%) respondents reported receiving training on infection prevention and control against COVID-19. Most of them received training from their workplace/hospital (12.2%), while 10.2% were trained via webinars. More of the respondents had moderate risk perception (n=17, 34.7%) while a majority of them had good practice of precautionary measures against COVID-19 (n=28, 57.1%). Conclusion: most of the study participants had moderate risk perception and good practice of precautionary measures. Risk perception was not a significant predictor of practice of precautionary measures.

COVID-19 pandemic: an assessment of risk perception and the implementation of precautionary measures in a group of primary care workers in Nigeria.

Introduction: The world is currently faced with the challenge of the COVID-19 pandemic, with healthcare workers at high risk of contracting infection. This study assessed the risk perception of COVID-19 and practice of precautionary measures against its spread by primary care workers. Methods: This was a descriptive cross-sectional study of primary care workers in the General Practice Clinic (GPC) of University of Benin Teaching Hospital (UBTH), Nigeria, sub-Saharan Africa. A pretested self-administered semi-structured questionnaire was employed to obtain data on Socio-demographic characteristics, Risk perception of COVID-19, and Practice of precautionary measures from the respondents. Obtained data were analysed using IBM SPSS Statistics version 22.0 (Chicago, IL, USA). Chi-square test, Ordinal regression analysis and logistic regression analysis were performed. A p-value of less than 0.05 was considered statistically significant. Ethical clearance was obtained from the Health Research Ethics Committee. Results: Most respondents (39.6%) had moderate risk perception of COVID-19. High risk perception was more frequent in females than males (27.8 vs 11.9%; Chi-square test; p-value = 0.001). Majority (76.0%) of the respondents had good practice of precautionary measures against COVID-19. Conclusions: Most HCWs surveyed in this study had moderate-risk perception of COVID-19 and good practice of precautionary measures. It is recommended that formal training and retraining on Infection Prevention and Control (IPC) of infections, including COVID-19, should be regularly provided for all cadres of healthcare staff.

The Two-way Referral System: A Survey of Medical and Dental Consultants in a Tertiary Hospital in Nigeria.

Background: Referral has been defined as a set of activities undertaken by a health care provider or facility in response to its inability to provide the necessary intervention to satisfy a patient's need. In a referral process, both Medical and Dental Consultants (Specialists) and Primary care physicians have essential roles to play. This study assessed the knowledge and practice of the two-way referral system by Medical and Dental Consultants in a tertiary hospital and their attitude towards it. Methodology: This was a descriptive cross-sectional questionnaire-based study of Medical and Dental Consultants in a tertiary hospital. Data analysis was done using IBM SPSS Statistics version 21.0 (Chicago, IL, USA)statistical software, with Pearson's chi-square used to determine associations between variables. Statistical significance was set at a P-value of < 0.05. Results: There were 118 respondents with 84 males and 34 females (M: F = 1:0.4). Though most of them had good knowledge of the two-way referral system, only 13.6% always referred the patient back to the primary care physician after specialist treatment. Of the respondents who never referred the patient back to the primary care physician, 44.4% stated there was no need for feedback to the primary care physician because they felt the patient became theirs after the initiation of a referral to them (specialist). Conclusion: Though most of the Medical and Dental Consultants were aware of the two-way referral system and had good knowledge of it, their practice of the two-way referral system was poor.

Referral Decision-Making: An Assessment of Family Physicians in a Tertiary Hospital in Nigeria.

Background: Family physicians offer first contact, comprehensive and coordinated care to patients, and refer those in need of further specialist care to specialists in other clinical departments. This referral decision-making is dependent on certain factors which can lead to variations in the pattern of referrals with impact on the coping capacity of a health facility. This study sought to assess the factors influencing referral decision-makingof family physicians in a tertiary hospital in Nigeria. Methodology: This was a descriptive cross-sectionalstudy of Family physicians in a tertiary hospital in Nigeria. It utilized a semi-structured, pre-tested self-administered questionnaire to obtain information on respondents' socio-demographic characteristics and factors that influenced respondents' referral decision. IBM SPSS Statistics version 22.0 (Chicago, IL, USA) statistical software was utilized for data analysis. A p-value of less than 0.05 was considered statistically significant. Results: The most reported factors that influenced the clinical decision of respondents to refer patients were the need for definitive treatment or surgery, 35(94.6%) and the need for a specific investigation,26 (70.3%). The least stated factors were: to save cost, patient's gender, patient's attitude and poor adherence to treatment plan, with equal proportions of 2.7% respectively. Conclusion: The most reported factors that influenced the clinical decision of respondents to refer patients were the need for definitive treatment or surgery, and the need for a specific investigation. Work status and the length of practice in Family medicine were also found to play a role in the clinical decision of respondents to refer a patient.

An Overview of Peripheral Artery Disease in the Elderly: A Study in a Tertiary Hospital Southern Nigeria.

BACKGROUND: The incidence of Peripheral Artery Disease (PAD), one of the manifestations of atherosclerosis, is increasing worldwide with significant effects on the quality of life. The disease is a strong prognostic marker for future cardiovascular events in people over 60 years, but relatively little is known about the condition among the elderly in sub-Saharan Africa. OBJECTIVE: The objective of this study was to determine the prevalence and pattern of peripheral artery disease in elderly patients. Materials and Methods: A cross-sectional hospital-based study was carried out among elderly patients aged 60 years and above attending the Geriatric Clinic of the Department of Family Medicine of University of Benin Teaching Hospital, Edo State, Nigeria, from September to November 2017. Using systematic random sampling technique, 370 respondents were recruited from a sampling frame of 2160 respondents and a sampling fraction of 6. A structured questionnaire was administered to collect data on sociodemographic characteristics, lifestyle variable, and medical history. The ankle-brachial index (ABI) and toe-brachial index (TBI) were used to assess for PAD. The analysis was done using descriptive statistics. RESULTS: The mean age was 69.3 ± 7 years comprising 76.5% females, 50% of the respondents were married, while 47% were widowed. The ABI showed 35.4% prevalence of PAD, while TBI for respondents with elevated ABI was 45.0%. CONCLUSION: The study showed a point prevalence of PAD to be 37.8%. From the total respondents, 45.7% had mild, while 2.9% had severe PAD. Routine screening for PAD is recommended for the early detection and management.

Nigeria's National Health Act: An assessment of health professionals' knowledge and perception.

BACKGROUND: Nigeria's National Health Act 2014 (NHA 2014) was signed into law on October 31, 2014. It provides a legal framework for the regulation, development, and management of Nigeria's Health System. This study assessed the knowledge and perception of the NHA 2014 by health professionals. MATERIALS AND METHODS: This was a descriptive, cross-sectional, questionnaire-based study conducted in December 2015, in Ota, Ogun State, Nigeria. Data entry and analysis were done using the Statistical Package for the Social Sciences version 16 (IBM SPSS, Chicago, IL, USA) statistical software, with Pearson's Chi-square, which is used to determine the associations between variables. Statistical significance was set at a P < 0.05. RESULTS: The study population comprised 130 health professionals (medical doctors/dentists, nurses, pharmacists, laboratory scientists, and other health-related professionals) in attendance at a medical conference. The respondents' age ranged from 21 to 75 years with a mean age of 44.53 ± 12.46 years. Medical practitioners accounted for 82.3% of the respondents. Although most (79.2%) respondents had a good perception of the NHA 2014 with majority (86.2%) claiming they were aware of the act, majority (73.8%) exhibited poor knowledge of the act. A little more than half (53.1%) of the respondents believed that the NHA 2014 will help to reduce strike actions in the health sector. CONCLUSION: Although health professionals in Nigeria have good awareness and perception of the NHA 2014, their knowledge of the Act is poor.

Typhoid fever in a Tertiary Hospital in Nigeria: Another look at the Widal agglutination test as a preferred option for diagnosis.

BACKGROUND: Single Widal agglutination test rather than blood culture, is commonly employed to diagnose typhoid fever in Nigeria. We took another look at the Widal agglutination test as a preferred option for diagnosis of typhoid fever by determining the specificity and sensitivity of Widal agglutination test in febrile adult patients. MATERIALS AND METHODS: Two hundred and seventy-one blood samples from consecutive adults (>18 years) with febrile illness attending the General Practice Clinic of the University of Benin Teaching Hospital were tested using the Widal agglutination test, blood culture, and malaria parasite test on each sample to establish the diagnosis of typhoid fever. RESULTS: Of the 271 blood samples 124 (45.76%) were positive following a Widal agglutination test, 60 (22.10%) blood samples grew Salmonella organisms on blood culture while 55 (20.29%) blood samples showed a co-infection of typhoid fever and malaria. A sensitivity of 35%, specificity of 51%, positive predictive value of 17%, and a negative predictive value of 73% were observed for Widal agglutination test as a diagnostic modality for typhoid fever infection. CONCLUSION: A single Widal agglutination test is not a valid diagnostic option for typhoid fever while co-infection with malaria parasite is the preponderant microbiological finding in typhoid fever infections. The severity of malaria parasitemia is associated with positive titers on Widal test.