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Introduction: Rural doctors typically work in low resource settings and with limited professional support. They are sometimes pushed to the limits of their usual scope of practice to provide the medical care needed by their community. In a previous phenomenological study, we described the concept of clinical courage as underpinning rural doctors' work in this context. In this paper, we draw on rural doctors' experiences during the unfolding COVID pandemic to re examine our understanding of the attributes of clinical courage. Methods: Semi structured interviews were conducted with rural doctors from 11 countries who had experience preparing for or managing patients with COVID 19. Interviews were transcribed verbatim and coded using NVivo. A deductive thematic analysis was undertaken to identify common ideas and responses related to the features of clinical courage. Results: Thirteen interviews from rural doctors during the unfolding COVID 19 pandemic affirmed and enriched our understanding of the attributes of clinical courage, particularly the leadership role rural doctors can have within their communities. Conclusion: This study extended our understanding that rural doctors' experience of clinical courage is consistent amongst participants in many parts of the world, including developing countries. [ABSTRACT FROM AUTHOR]

Inadequate support services for common breastfeeding problems are major reasons why many nursing mothers quit exclusive breastfeeding practice in Nigeria. The recent exodus of doctors and other health-care workers has made the situation worse. Community-based interventions are urgently needed to avoid a relapse of the marginal increase of the exclusive breastfeeding rate in the country. Therefore, this study reviewed the feasibility and effectiveness of training and deploying pastors' wives as breastfeeding peer counselors along with leaders of women's Bible study classes as co-counselors in a church-based support service to boost exclusive breastfeeding practice in the country. Searches were conducted using appropriate keywords in journals and databases such as Google Scholar, Christian Journal of Global Health, and PubMed. Relevant papers were selected and read thoroughly. Ideas, phrases, and clauses that answered the research questions were synthesized into themes. Previous partnerships with the church to provide support for specific health problems such as HIV/AIDS had been fruitful. The adoption of the Community Infant and Young Child Feeding Counseling Package in small priority areas by the government and its development partners yielded positive results. However, partnerships are necessary to make the service available nationwide. The use of existing opportunities such as the network of pastors' will be an economical and rational form of the volunteer community mobilizers. Community-based breastfeeding peer counseling has effectively increased the initiation and duration of exclusive breastfeeding and provided an opportunity to address other problems related to breastfeeding. However, the allocation of matching grants to local government areas will be necessary to increase nutrition interventions and to motivate peer counselors. [ABSTRACT FROM AUTHOR]

Purpose/Aims: This research aimed to study the profile, perceptions, barriers, and predictors of Nigerian resident doctors' level of engagement in scientific research. Methods: This study was a descriptive cross-sectional quantitative survey of 438 resident doctors in Nigeria. This study forms a part of the big CHARTING Study, the protocol of which was published in "Nigeria Journal of Medicine 2019;28:198-205." Results: Three hundred and eighteen (72.8%) respondents were male and 119 (27.2%) were female. There were 229 (52.4%) registrars and 208 (47.6%) senior registrars, while residents in surgical versus nonsurgical specialties were 190 (44.5%) and 237 (55.5%), respectively. Three hundred and sixty-eight (85%) respondents had participated previously in research; 67 (15.6%) and 72 (16.6%) had their papers published in local or international journals, respectively; and only 46 (10.6%) had held first authorship positions in peer-reviewed journal publications. The significant barriers to research identified among them included lack of funding, lack of free time, inadequate training/knowledge on research methodology, and the onerous nature of clinical research. The independent predictor of previous engagement with research was years on current job (P = 0.007). This was similar to finding for the first authorship of a peer-reviewed article among the respondents (0.017). Conclusion: This study concludes that publication and grantsmanship rates were very low among the surveyed resident doctors, despite their high rate of engagement in research projects. There is a need for increased research capacity building among resident doctors in Nigeria. [ABSTRACT FROM AUTHOR]

Objective: This study assessed health-care workers' awareness of the health and environmental hazards associated with plastic bags and available substitutes. Methods: This cross-sectional questionnaire-based survey was carried out in two rural hospitals in Northwest Nigeria over a 4-week study period. It included permanently employed health workers who were residents in the study community. The data were analyzed using SPSS version-20; the association between respondents' sociodemographic characteristics and awareness of the harmful effects of plastic-bags was determined using the Chi-square test. Results: There were 200 respondents aged 20-55 years with a mean of 31.7 ± 8.6 years. Most, 45% (90/200), respondents were nurses/midwives; 21% (42/200) were doctors. Most respondents, 49% (98/200), would throw away the plastic bags after a single use; 23.5% (47/200) would keep and reuse, while 45.5% (91/200) use reusable bags for shopping. Most respondents, 91% (182/200), were aware of the harmful effect on the environment, while 74% (148/200) knew it could be harmful to health. Respondents' age (>30 years) was significantly associated with awareness of the harmful effects of used plastic bags (P = 0.03), while male gender, age >30 years, being married, and of non-Hausa/Fulani ethnicity were associated with awareness of plastic-bag substitutes. Conclusions: Most respondents were aware of the health and environmental hazards of plastic bags and the available substitutes. Promoting reuse of plastic bags and the use of available substitutes will help to control this growing hazard. [ABSTRACT FROM AUTHOR]

Introduction: Histopathology Request Forms (HRFs) serve as interphase between clinicians and pathologists in making diagnosis of tissue pathology. Inadequacies of the completion of HRFs have been a source of major frictions between the two groups of physicians. Various reports have highlighted this inadequacy. The need for adequate information on the HRF to be standardized cannot be overemphasized. Aim: The paper aims to evaluate the histopathology request forms from institutions in Nigeria and to propose an improved prostate disease-specific histopathology request form. Methodology: Histopathological request forms from some major Nigerian health institutions were analyzed for adequacy based on required information for a standardized histological reportage. A request form specific for suspected prostate diseases was designed from the review of literature. Results: Histopathology request forms (HRFs) from sixteen Nigerian health institutions were received from all the geopolitical zones of the country following a request. All the HRFs were neither organ nor disease specific. None of the HRFs was adjudged to be satisfactory to produce enough information adequate for comprehensive histopathology reportage. A prostate disease-specific histological request form is proposed following review of literature. Discussion: The need for a comprehensive prostate-specific HRF cannot be overemphasized to improve the relationships between surgeons and pathologists and to improve reportage of prostate pathologies and the management of prostatic diseases. Conclusion: Adequate clinical information is needed for early and complete reportage of histopathological report of prostate diseases. [ABSTRACT FROM AUTHOR]

Background: Increased breast density is a known risk factor for breast cancer; as such, it is a pertinent consideration for any breast cancer awareness and screening exercise. Ultrasound is the most frequently requested breast imaging examination and is the preferred imaging modality for assessing dense breasts. Objectives: This paper aims at describing the sonographic breast density patterns among women in Zaria using the American College of Radiology breast imaging and reporting data system (BIRADS) lexicon to estimate the prevalence of different breast sonographic patterns in Zaria and to relate this with age, parity, and menopausal status of the women studied. Materials and Methods: This was a cross-sectional descriptive study of the sociodemographic and sonographic data of 503 women who presented for breast ultrasound at the Radiology department of Ahmadu Bello University Teaching hospital, Zaria, Nigeria between July 2014 and December 2016. Breast scans were performed using a Mindray DC-8 Ultrasound machine, equipped with a 7–12 mHz transducer. Data were analyzed using statistical package for social sciences software for windows version 20 (SPSS, Inc. Chicago Illinois, USA). Results: Five hundred and three women participated in the study. There were 415 premenopausal and 88 postmenopausal women whose mean age was 36.1 ± 12.8 years. The most common breast density pattern was heterogenous (49.1%), which was independent of family history of breast cancer. The least common breast density pattern was homogenous fibroglandular. Breast density decreased significantly with increasing age, parity, and menopausal status (P < 0.001). Conclusion: Heterogenous pattern (ACR type 3) was the predominant breast density pattern in this study. Because this breast pattern has been significantly associated with breast cancer, further studies are needed to estimate cancer risk among our women. [ABSTRACT FROM AUTHOR]

Background: An outbreak of Ebola disease was declared in Lagos, South West Nigeria, on 23rd July 2014. Later, the outbreak spread to the south south and south eastern part of the country. The last cases occurred on August 31, 2014 and the country was certified to be Ebola free on 20th October, 2014. This paper describes the experiences and implications of the Ebola outbreak for Nigerian women. Subjects and Methods: Identification and listing of cases and contacts was done in Lagos, Port Harcourt and Enugu. Socio demographic information was collected. Results: Women made up 55% of Ebola cases and 56.6% of contacts traced. Of the 8 deaths reported 50.0% (4) were women, of which 75.0% (3) were health care providers. The sex specific case attack and fatality rates for males and females were 2.2% versus 2.3% and 45.5% versus 33.3% respectively. The women restricted their movement in order to avoid the infection. The outbreak affected their utilisation of health care services and livelihood. Conclusion: Women were exposed occupationally and domestically due to their care giving roles. In health facilities, they were directly involved in the care or encountered persons who had been in contact with persons with Ebola. In the homes, they were at the forefront of nursing the sick. There is the need to ensure women have access to information, services and personal protective equipment to enable them protect themselves from infection. Education and engagement of women is crucial to protect women from infection and for prompt outbreak containment. [ABSTRACT FROM AUTHOR]

Background: Cleft lip (CL) and palate (CLP) management is multidisciplinary. A cleft team was formed in a Nigerian Tertiary Hospital to address the health needs of cleft patients in the centre.Aim: This paper aims at documenting the Aminu Kano Teaching Hospital (AKTH) management protocol for orofacial clefts and also to review our experience with CLP surgeries performed at AKTH since our partnering with Smile Train.Materials and Methods: A retrospective review of all the cleft patients surgically treated from January 2006 to December 2014 under Smile Train sponsorship was undertaken. A descriptive narrative of the cleft team protocol was also given.Results: One hundred and fifty-five patients (80 males, 75 females) had surgical repairs of either the lip or palate. CL patients were 83 (53.55%), while CLP patients were 45 (29.03%) and isolated cleft palate patients were 27 (17.42%).Conclusion: The inclusion of various specialities in the cleft team is highly desirable. Poverty level amongst our patients frequently limits our management to surgical treatment sponsored by the Smile Train, despite the presence of other residual problems. [ABSTRACT FROM AUTHOR]

This paper highlights the tenets of globalization and how its elements havespread to sub-Saharan Africa, and Nigeria in particular. It assesses the growing burden of non-communicable diseases (NCDs) in Nigeria and its relationship with globalization. It further describes the conceptual framework on which to view the impact of globalization on NCDs in Nigeria. It assesses the Nigerian dimension of the relationship between the risk factors of NCDs and globalization. Appropriate recommendations on tackling the burden of NCDs in Nigeria based on cost-effective, culturally sensitive, and evidence-based interventions are highlighted. [ABSTRACT FROM AUTHOR]

Aim: To determine the teaching methods used by residents in paediatric surgery in Nigeria and their exposure to research and conferences. Materials and Methods: A structured questionnaire was administered to trainees in paediatric surgery in Nigeria seeking information regarding different teaching methods used, frequency of use, involvement in research and participation in conferences. Results: There were 11 respondents (91.6%) of 12 questionnaires that were distributed. All of them were training in accredited teaching hospitals in Nigeria. All of them had been involved in teaching medical students. Ten residents were involved in teaching in wards/bedside two times or more in a week and all were involved in teaching at the clinics. Only one resident used audiovisual aid at least once a week to teach students. Eight trainees used tutorial or seminar group discussion as a teaching tool once a week. Four trainees had not used written essay as a way of teaching students while five had never given students lectures in a classroom before. All the respondents had participated in retrospective research while nine had been involved in prospective research. Nine residents had attended conferences nationally while two had attended international conferences. Six trainees presented a paper or more at national conferences while one presented at an international conference. Conclusion: Trainees in paediatric surgery in Nigeria are significantly involved in the teaching of undergraduate medical students and clinical research. This should be encouraged and further enhanced by motivating the trainees to attend international conferences. [ABSTRACT FROM AUTHOR]

Context: Swenson's pull-through is one of the standard operations for the treatment of children with Hirschsprung's disease. Complications arising from the operation are difficult to treat because of fibrosis in the pelvis. The posterior sagittal approach may be a safer alternative. Aims: The aim of this paper is to highlight our experience with the use of the posterior sagittal trans-sphincteric approach to treat unusual complications of Swenson's pull-through. Settings and Design: A retrospective study of four patients who had posterior sagittal repair of their complications of Swenson pull-through at the Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria. Materials and Methods: Four cases of Hirschsprung's disease that developed post-Swenson pull-through complications are presented. There were three males and one female. Their age ranged between 10 months and 15 years. The patients had rectovaginal fistula, rectourethral fistula, high trans-sphincteric fistula-in-ano and complete anastomotic disruption. Result: All the patients were successfully treated using the posterior sagittal approach. The approach was used twice in one patient without significant sequelae. The three patients were old enough to be assessed and had a Kelly score of 4-6 at follow-up. Conclusion: The posterior sagittal technique offers a safe approach to treat the complications of Swenson pull-through. [ABSTRACT FROM AUTHOR]