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PURPOSE: To evaluate the effect of electronic and paper-based standardized nursing care plans (SNCPs) use on quality of nurses’ documentation. METHODS: Using quasi-experimental design, two wards were grouped into electronic and paper-based wards. Nurses were trained to use electronic- and paperbased SNCPs for care-planning and documentation. Data was collected before, 3, and 6 months postintervention and analyzed with SPSS version 20. FINDINGS: There was improvement in documentation quality in the two wards after introducing SNCPs with higher quality scores in the electronic ward postintervention. CONCLUSION: Providing SNCPs in electronic and paper formats is critical to improving nursing documentation. IMPLICATION FOR NURSING PRACTICE: Adequate training and support for nurses are needed for successful implementation of SNCPs in electronic health records (EHRs) in developing nations. [ABSTRACT FROM AUTHOR]

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Purpose: This study aims at translating and adapting a common and widely used proxy rated cognitive screening tool – Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) into Hausa language and also to evaluate the instrument's psychometric properties. Design/methodology/approach: IQCODE was translated and adapted using a qualitative process involving experts and the adapted version was then evaluated against a gold standard (Diagnostic and Statistical Manual of Mental Disorder V criteria for neurocognitive disorders) with older adults subjects (N = 100), while its reliability (internal consistency) was also evaluated. Descriptive statistics of mean and frequencies, and inferential statistic of receiver operating curve analysis and Cronbach's alpha coefficient were used for data analysis at an alpha level set at 0.05. Findings: The Hausa IQCODE has a sensitivity value of 73.3%, specificity value of 71.8% and optimal cut-off values of between 3.2 and 3.3. For his adapted instrument the area under the Curve (AUC) curve is 0.79 (95% CI: 0.663–0.919; std. err: 0.066; P = 0.000), and Cronbach's alpha value of 0.819 was obtained indicating that the adapted instrument has good internal consistency. Research limitations/implications: The adapted IQCODE is a valid and reliable proxy based cognitive screening tool for the older adult Hausa speakers in Maiduguri. However, clinician and researcher might want to consider different optimal cut-off points when using this tool to screen or to monitor cognitive changes among older adults. Originality/value: This research paper translated and adapted Hausa IQCODE into Hausa language. And it gives information on the validity and reliability of the adapted tool alongside with new optimal cut-off for cognitive screening by proxy among older adult patients in Nigeria. [ABSTRACT FROM AUTHOR]

Background: The ongoing Boko Haram insurgency in northeastern Nigeria has depleted the country's capability to deliver quality healthcare to her citizenry. The ailing health sector is overwhelmed with a rising incidence and prevalence of infectious and non-communicable diseases. Aim: The aim of this paper was to determine the trend of kidney disease, end-stage renal disease (ESRD), anaemia, malnutrition and human immunodeficiency virus (HIV) in northeastern Nigeria. Materials and methods: Data covering different periods between 1999 and 2017 were obtained from the University of Maiduguri Teaching Hospital (UMTH), Maiduguri in northeastern Nigeria. This hospital is the largest tertiary healthcare facility in the region. The data were demographic in nature, i.e. sex, age or simply the registered cases. A quadratic model of time-series analysis was used to create the various trends of the respective diseases with the aid of Minitab software (version 18.0). t-Tests and analysis of variance (ANOVA) were also performed, with a p-value of less than or equal to 0.05 being considered significant. Results: About three out of every five patients treated for kidney disease were male, while three out of every five patients treated for HIV were female. Patients between the ages of 31 and 50 years were at the greatest risk of developing kidney disease. The mean distribution of disease incidence was the same for both sexes for kidney disease, anaemia, malnutrition and HIV. The mean distribution disease incidence was different between age groups for kidney disease but the same for anaemia. The incidence of anaemia and malnutrition reported was almost the same for both sexes. Children under the age of 10 years old were at the most risk of anaemia, with the distribution decreasing with increasing age. The trend analysis of the incidence of kidney disease, ESRD, anaemia and malnutrition showed that these ailments were on the increase, while the number of patients that were on antiretroviral therapy (ART) was on the decline in northeastern Nigeria. Conclusion: These increasing trends are evidences of the effect of Boko Haram on the public health of the people of northeastern Nigeria and will continue to be a public health concern for the region and the country as a whole. [ABSTRACT FROM AUTHOR]

In this paper, we walk you through our challenges, successes, and experience while participating in a Global Health Outreach Project at the University College Hospital (UCH) Ibadan, Nigeria. The scope of the project was to install a Picture Archive and Communication System (PACS) to establish a centralized viewing network at UCH's Radiology Department, for each of their digital modalities. Installing a PACS requires robust servers, the ability to retrieve and archive studies, ensuring workstations can view studies, and the configuration of imaging modalities to send studies. We anticipated that we might experience hurdles for each of these requirements, due to limited resources and without the availability to make a site visit prior to the start of the project. While we ultimately experienced delays and troubleshooting was required at each turn of the install, with the help of dedicated volunteers both on and off-site and the UCH staff, our shared goal was accomplished. [ABSTRACT FROM AUTHOR]

Background: Maternal death reviews and obstetric audits identify causes and circumstances related to occurrence of a maternal death or serious complication and inform improvements in quality of care. Given Nigeria's high maternal mortality, the lessons learned from past experiences can provide a good evidence base for informed decision making. We aimed to synthesise findings from maternal death reviews and other obstetric audits conducted in Nigeria through a systematic review, seeking to identify common barriers and enabling factors related to the provision of emergency obstetric care. Methods: We searched for maternal death reviews and obstetric care audits reported in the published literature from 2000-2014. A 'best-fit' framework approach was used to extract data using a structured data extraction form. The articles that met the inclusion criteria were assessed using a nine point quality score. Results: Of the 1,841 abstracts and titles at initial screening, 329 full text articles were reviewed and 43 papers fulfilled the inclusion criteria. Four types of barriers were reported related to: transport and referral; health workers; availability of services; and organisational factors. Three elements stand out in Nigeria as contributing to maternal mortality: delays in Caesarean section, unavailability of magnesium sulphate and lack of safe blood transfusion services. Conclusions: Obstetric care reviews and audits are useful activities to undertake and should be promoted by improving the processes used to conduct them, as well as extending their implementation to rural and basic level health facilities and to the community. Urgent areas for quality improvement in obstetric care, even in tertiary and teaching hospitals should focus on organisational factors to reduce delays in conducting Caesarean section and making blood and magnesium sulphate available for all who need these interventions. [ABSTRACT FROM AUTHOR]

Background: The WHO global action plan on antibiotic resistance (ABR) emphasises improving awareness of ABR and optimising antibiotic use. Objectives: To assess physicians' and pharmacists' knowledge and perceptions of ABR and antibiotic stewardship (AS) and hospital preparedness to implement AS. Methods: This descriptive cross-sectional survey included 124 physicians and 61 pharmacists from the University of Uyo Teaching Hospital, Akwa Ibom State, Nigeria. Participants were given a 16-item questionnaire during their clinical/review meetings. The data were analysed with SPSS version 25.0. Results: Both physicians (98%) and pharmacists (97%) perceived ABR as a global and national concern. Only 47% of physicians and 53% of pharmacists accurately defined AS. More pharmacists (70%) than physicians (45%) knew that excessive antibiotic usage in agriculture and livestock causes resistance (p = 0.002) and that prompt de-escalation of empirical antibiotic therapy based on culture/sensitivity results reduces ABR (93% vs. 79%, respectively, p = 0.013). Knowledge scores varied among physicians according to position (p = 0.002), length of practice (p < 0.001), and age (p = 0.002); only pharmacists' age (p = 0.046) was associated with their knowledge level. Conclusions: Participants demonstrated good knowledge of ABR and AS strategies but little awareness about the hospital's intention to implement AS programmes. Hospital management should emphasise optimising antibiotic use through AS programmes. [ABSTRACT FROM AUTHOR]

Purpose - The prevalence of Human Immunodeficiency Virus (HIV) is about four times higher among individuals with same-sex orientation as against the general population. This may be partly due to judgmental, heteronormative attitudes among health workers, thereby affecting access to care. Therefore, the purpose of this paper is to assess the perception of final-year medical students of Olabisi Onabanjo University, Nigeria on sexual orientation and its implications on access to HIV care and support services. Design/methodology/approach - A cross-sectional descriptive study was conducted among final-year medical students. Data were collected using an interviewer-administered questionnaire and analyzed using SPSS 20. Relevant descriptive and inferential statistics were calculated. Participation was fully voluntary. Findings - More males (70 percent) were aware of the concept of sexual orientation than females (60.4 percent). Most (94 percent) males and all female respondents felt homosexuality was against the order of nature. More males (76 percent) than females (62.3 percent) felt men having sex with men and homosexuality were synonymous. More females (50.9 percent) than males (48 percent) felt gay doctors should not be employed in public hospitals. Originality/value - Respondents had a poor perception of sexual orientation and there were no significant differences between genders. This could contribute to existing stigmatization against individuals with minority sexual orientations. It should be addressed in the medical curriculum. [ABSTRACT FROM AUTHOR]

The maternal mortality ratio (MMR) of Nigeria remains high. This retrospective study aims to suggest evidence-based strategies towards achieving the sustainable development goal target 3.1 at the Obafemi Awolowo University Teaching Hospital (OAUTHC), Nigeria by providing contemporary data on MMR between October 2012 and September 2015. There were 86 maternal deaths and 5243 live births over the triennium, with annual MMRs of 1744, 1622 and 1512/100,000 live births, respectively. Fifty-six (65.2%) were postpartum deaths, while 44 (51.2%) occurred within 12 hours of admission. Using the WHO ICD-10 system, the causes of mortality were pregnancy-related infections; 26 (30.2%), haemorrhage; 20 (23.3%), hypertension; 13 (15.2%) and pregnancies with abortive outcomes; 11 (12.7%). Financial constraints, misdiagnosis and delayed referrals constituted the predominant contributors. The MMR at OAUTHC, Nigeria in the last triennium of the MDG was 'Extremely High'. Improved aseptic techniques, blood transfusion services, antimicrobial sensitivity evaluation, Universal Health Coverage, training-retraining of skilled birth-attendants and effective referral systems are advocated. IMPACT STATEMENT What is already known on the subject of the paper: Nigeria now contributes the largest proportion (19%) of the burden of maternal mortality worldwide, despite constituting just 2% of the global population. Reversing this adverse trend during the sustainable development goal (SDG) period demands effective strategies, which can only be predicated on reliable data at the hospital, regional and national levels.What This Study Adds: This article provides the contemporary maternal mortality data of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, during the last triennium of the Millennium Development Goal era. The findings from the study revealed that the average maternal mortality ratio (MMR) of the Hospital over the three years was 1640/100,000 live births, and that pregnancy-related infection is now the leading cause of maternal death, followed by obstetric haemorrhage. What the implications are for clinical practice: Improvement in aseptic techniques, evaluation of antimicrobial sensitivity patterns and efficient blood transfusion services, as well as Universal Health Insurance coverage and Skilled Birth Attendants will improve the maternal health indices of the hospital, and ultimately the country during the SDG execution period. [ABSTRACT FROM AUTHOR]

Background: Nursing training focuses more on health promotion and saving lives rather than preparing for the end of life. Although nursing encompasses care at the beginning and end-of-life, nurses are not prepared for end-of-life care and death of patients. Studies have attempted to identify and describe the effects of patients' deaths on nurses, but very few studies have described the experiences of nurses dealing with paediatric death. The study determined TO explore the effect of the Yoruba culture on the lived experiences of clinical nurses following death of paediatric patients, and describe the coping strategies adopted by nurses to reduce the effect of the lived experiences in selected hospitals in Ilorin. Method: A hermeneutic qualitative study design was used to describe and give meaning to the experiences of the participants at the University of Ilorin Teaching Hospital, Ilorin, and Children Specialist Hospital, Centre-Igboro, Ilorin, Kwara state. Data was collected using semi-structured in-depth interview guide, and face-to-face interviews were conducted among 21 participants. Content and thematic analysis, and Atlas TI were used to analyse data. Findings: Four themes were identified; cultural and religious beliefs and practices about a child's death, reactions to a child's death, coping strategies learned on their first experience of a child's death, coping techniques adopted by nurses. Culture has a major influence on the nurses' lived experiences and grieving, due to the varying beliefs of the religious and ethnic cultures, nurses feel inadequate in providing comfort to grieving parents. They also feel it is unprofessional to cry or grieve openly following the death of patients. The major coping strategy adopted by nurses is that they are more committed to their work. Linking Evidence to Action: The study found that nurses use work as their most effective coping strategy following the death of paediatric patients. They also strive to provide their best possible care in spite of their reactions to death [ABSTRACT FROM AUTHOR]

Hospice and palliative care development, in terms of availability and services, occur to varying degrees in the developing world. In this paper, the evolution of palliative care practices in four developing nations ( Nigeria, Georgia, Ethiopia and Tanzania) is described. By highlighting common problems as well as the unique individual perspectives of each country's practice, this paper aims at increasing global awareness of palliative care in the developing world. While the call for palliative care to become a fundamental human right is sustained, it is also hoped that this article will stimulate a global discussion on the best possible way to encourage the establishment and growth of palliative care services in other developing countries where hitherto it has not been in existence, with policymakers and healthcare professionals taking the lead through the institution of sound national policies to promote and provide palliative care to all citizenry. [ABSTRACT FROM AUTHOR]

This paper presents the challenges and barriers to accessing formal maternity care in South East Nigeria from women's perspectives. It is drawn from a study that explored the concept of safe motherhood. The study used a hermeneutic phenomenological approach guided by post-structural feminism. Data were collected through individual semi-structured interviews with 17 women who were attending a formal healthcare facility for antenatal care. Four aspects of the challenges and barriers encountered by women when accessing care in a formal healthcare setting as reported by the participants of the study are as follows: financial constraints, lack of autonomy, negative attitude of the healthcare providers, and healthcare worker strikes. Some participants linked the economic status of women to the lack of education which had an impact on their ability to make an independent decision as to whether to seek formal maternity healthcare or not. Negative attitudes, and frequent strikes of healthcare workers in many cases, discourage women from using the formal maternity healthcare facilities. It is evident that Nigeria did not achieve the Millennium Development Goal (MDG) 5, which is to improve maternal health. Achieving the Sustainable Development Goal (SDG) 3.1, which is to reduce the global maternal mortality ratio, requires more than technical approaches. Genuine political will is required if the health system is to be affordable for all women. There is the need to address the gender-related issues that sustain women's low socio-economic status. The government needs to pay the workers as and when due, and a performance appraisal should be in place to ensure improvement in the quality of care offered to women. [ABSTRACT FROM AUTHOR]

Background. There is a need for critical care services outside intensive care units (ICUs), especially in emergency departments (EDs). However, there is a paucity of skilled manpower for ED critical care or emergency critical care (ECC) in resource-limited settings. Objective. To evaluate the impact of bedside training on emergency critical care practices of clinical staff. Methods. This was a quasi-experimental study using a pretest - post-test design in a paediatric ED. The intervention was a six-week structured bedside training on bubble continuous positive airway pressure (CPAP) high-flow nasal cannula (HFNC) and mechanical ventilation. Participants' actual ECC practices pre and post training were evaluated, including their perceived proficiency on an uncalibrated 100 mm visual analogue scale (VAS). Descriptive and inferential analyses were done; p<0.05 was considered significant. Results. A total of 35 clinical staff participated in the training, comprising 9 (24.3%) paediatric registrars, 12 (32.5%) senior registrars, 10 (27.0%) nurses, 4 (10.8%) house officers and 2 (5.4%) paediatric consultants. The male: female ratio of the participants was 1:1.6, and their mean (SD) age was 33.24 (6.30 years. Participants' understanding of testing the CPAP circuit, connecting the patient and weaning significantly improved following training (p=0.004). Their capacity to select appropriate HFNC parameters improved (p=0.013). They performed more endotracheal intubations in the post-training period (p=0.001). Their pretest-post-test proficiency in mechanical ventilation increased on VAS (mean scores 45.26+31.99 v. 63.26+22.26; p=0.038). Also, there was a significant increase in their perceived proficiency in paediatric analgesia/sedation (30.83+29.86 v. 49.83+23.90; p=0.029). Conclusion. Short-term bedside critical care training enhanced the self-reported competency of paediatric ED staff. There is a need for on-the-job ECC training and retraining of clinical staff in our setting. [ABSTRACT FROM AUTHOR]

Health care costs incurred prior to the appropriate patient–provider transaction (i.e., transaction costs of access to health care) are potential barriers to accessing health care in low- and middle-income countries. This paper explores these transaction costs and their implications for health system governance through a cross-sectional survey of adult patients who received their first diagnosis of pulmonary tuberculosis (TB) at the three designated secondary health centres for TB care in Ebonyi State, Nigeria. The patients provided information on their care-seeking pathways and the associated costs prior to reaching the appropriate provider. Of the 452 patients, 84% first consulted an inappropriate provider. Only 33% of inappropriate consultations were with qualified providers (QP); the rest were with informal providers such as pharmacy providers (PPs; 57%) and traditional providers (TP; 10%). Notably, 62% of total transaction costs were incurred during the first visit to an inappropriate provider and the mean transaction costs incurred was highest with QPs (US$30.20) compared with PPs (US$14.40) and TPs (US$15.70). These suggest that interventions for reducing transaction costs should include effective decentralisation to integrate TB care with services at the primary health care level, community engagement to address information asymmetry, enforcing regulations to keep informal providers within legal limits and facilitating referral linkages among formal and informal providers to increase early contact with appropriate providers. [ABSTRACT FROM PUBLISHER]

Nowadays, an electronic health information management system (EHIMS) is crucial for patient care in hospitals. This paper explores the aspects and elements that contribute to the success of EHIMS in Nigerian teaching hospitals. The study adopted a survey research design. The population of study comprised 442 health information management personnel in five teaching hospitals that had implemented EHIMS in Nigeria. A self-developed questionnaire was used as an instrument for data collection. The findings revealed that there is a positive, close relationship between all the identified factors and EHIMS's success: technical factors (r = 0.564, P < 0.05); social factors (r = 0.616, P < 0.05); organizational factors (r = 0.621, P < 0.05); financial factors (r = 0.705, P < 0.05); and political factors (r = 0.589, P < 0.05). We conclude that consideration of all the identified factors was highly significant for the success of EHIMS in Nigerian teaching hospitals. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic kidney disease (CKD) often complain of taste dysfunction. The prevalent taste dysfunction among patients with CKD predisposes them to malnutrition, poor quality of life, and worsen disease prognoses. To appropriately treat the taste dysfunction in this group of patients, it's imperative that factors that predict taste dysfunction and its severity are identified for prompt treatment. Aim: To identify factors associated with taste dysfunction and its severity among patients with CKD. Materials and Methods: This was a hospital-based case–control study of adult patients with CKD at the University College Hospital, Ibadan, Nigeria. The control group was made up of age- and gender-matched healthy volunteers with no clinical and laboratory evidence of CKD. Relevant clinical and social data obtained include demographics, symptoms, and signs of taste dysfunction and its risk factors. The 4 basic taste modalities namely sweet, sour, bitter, and salt taste senses of the participants were tested with validated "taste strips." Factors that predict taste dysfunction were identified among the spectrum of the disease. Results: There were 100 patients with CKD and 100 healthy controls, age ranges between 19 and 86 years (mean ± standard deviation [SD] = 46.3 ± 13.9 years) and 20 and 85 years (mean ± SD = 43.4 ± 14.9 years), respectively. There was no statistically significant difference between cases and control gender distribution (P =.57). Hypogeusia was found in 27.0% of patients with CKD, while total taste function score of all the control was within normal range. Increasing duration of CKD was identified as a predictor of taste dysfunction among patients with CKD (odds ratio: 4.889, P =.038). The stages of CKD had no statistically significant relationship with the severity of taste dysfunction (P =.629). Conclusion: The prevalence of taste dysfunction among patients with CKD was high and this showed significant correlation with increasing duration of CKD; in contrast, the severity of CKD is not significant in the development of taste dysfunction. [ABSTRACT FROM AUTHOR]

Menstrual hygiene is keeping the body clean while a woman is menstruating. Many females have encountered considerable difficulty maintaining menstrual hygiene because of a lack of awareness or access to menstrual products, particularly in low- and middle-income nations. However, knowledge and practice of menstrual hygiene among female undergraduates, especially in Nigeria, are understudied. This descriptive crosssectional study investigated the knowledge, practices and barriers associated with menstrual hygiene among female undergraduates of a private university in Nigeria. Three hundred and sixty-four participants were recruited using purposive sampling. Sociodemographic data, knowledge, practice and barriers associated with menstrual hygiene were assessed using a self-report knowledge and practice of menstrual hygiene questionnaire. Data were analyzed using descriptive statistics. The results revealed that most respondents (72.3%) had poor knowledge of menstrual hygiene, while around half (49.2%) maintained good practices. The most common barriers to practicing menstrual hygiene among the respondents were reported as fatigue and limited water access in their dormitories. Therefore, schools of higher learning need to ensure that students have regular access to clean water with adequate time between classes to allow for proper menstrual hygiene practice. Nurses could provide menstrual education for mothers and their adolescents before getting into university. Similarly, nurses working in institutions of higher learning should provide regular menstrual hygiene awareness programs on campus and advocate for access to clean water and hygiene facilities for female students undergoing menstruation. [ABSTRACT FROM AUTHOR]

The traditional medicine men are one of the commonly patronized healthcare service providers in Nigeria. In the northern Nigeria, there is a popular traditional treatment for body swellings called Sakkiya in Hausa language. This treatment involves the use of a hot pointed metallic tip to puncture a body swelling. This study aims to explore the clinical experience of clinicians domiciled in the Usmanu Danfodiyo University Teaching Hospital, UDUTH, Sokoto, North-western Nigeria, on the Sakkiya cases they have seen in their practice. Methods: This study surveyed a cross-section of 120 nurses, dentists, medical doctors, and community health extension workers (CHEWs) in UDUTH, Sokoto, on their clinical experience on the cases of patients with history of Sakkiya treatment using an anonymous paper questionnaire. Data obtained was analysed using the SPSS version 16 software. Results: The majority (78.3%) of the respondents were within the age range of 26 to 40 years, 73.3% of them were males, 56.7% were CHEWs, and 34.2% of them had been working as clinicians for 6 to 10 years. Most (83.3%) of them had also seen at least one case of Sakkiya in their clinical practice. The head and neck region is the most common part of the body where Sakkiya treatment is done. All, except 11 respondents reported that Sakkiya treatments do result into a life-threatening complication. The most common (50.8%) complication associated with Sakkiya treatment is scar formation. Conclusion: Sakkiya treatment is a popular traditional practice known to the surveyed clinicians in this present study. This treatment was considered by the surveyed clinicians to have no curative effect on body swellings, rather it has serious life-threatening complications associated with it. [ABSTRACT FROM AUTHOR]

Sakkiya is popular traditional treatment for body swelling in northern Nigeria. This treatment has been reported to have lethal health risks associated with it. Objectives: To explore the level of participation of clinicians in a northern Nigerian hospital in patient and community education on Sakkiya treatment. Methods: This study surveyed a sample of 120 clinicians domiciled in UDUTH, Sokoto, on their level of participation in patient and public education on the dangers associated with Sakkiya treatment. The survey instrument was a self-administered paper questionnaire. Results: More than three-fourth (78.3%) of the subjects were within the age range of 26 to 40 years, 73.3% of them were males, 56.7% were community health extension workers, and 34.2% of them had been working as clinicians for 6 to 10 years. Majority (84.2%) of the subjects perceived Sakkiya practice to be a problem of public health importance. Only 35.8% of the subjects did educate their patients with body swelling on the dangers of Sakkiya treatment always. Also, close to four-tenth (39.2%) of the subjects had never engaged themselves in community education on the problems associated with Sakkiya treatment. Conclusion: Public education on Sakkiya is a highly neglected area in the Nigerian public health. Caregivers need to pay more attention to educating their patients as well as the people in the communities on the health risks associated with Sakkiya treatment. [ABSTRACT FROM AUTHOR]

Introduction: Throughout the world, the number of persons with disabilities (PWDs) is growing exponentially as a result of factors such as population increase, ageing, and medical advances that prolong life. This has increased the demand for quality health services, especially in developing countries. Aim: The aim of this research is to assess the attitudes towards PWDs of “direct” and “indirect” healthcare service providers at the University College Hospital (UCH) in Ibadan, Nigeria. Methods: The researchers analyzed the open-ended comments from 81 healthcare providers from the hospital, regarding their knowledge and attitudes towards patients with disabilities. Results: The authors classified the unsolicited comments into three main categories, thus: “institutional-level actions advocated”, “society-level changes advocated”, and “individual-level perception or attitude.” Conclusion: This project has implications for reform and development of medical services in Nigeria. It identifies specific areas of need to improve the quality of healthcare service pertaining to PWDs and their families, especially in relation to the removal of architectural barriers, the development of positive attitudes, the formulation and implementation of effective legislation, and improved pre- and in-service training of healthcare workers in line with signed domestic and international protocols. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess the challenges to sustainability of standardized nursing care plan in selected tertiary health institutions in Nigeria. Methods: Using convergent mixed method design, the qualitative and quantitative data were collected from 427 nurses and nine stakeholders. This was done in one phase with the use of validated questionnaires and in‐depth interview guide/key informant interview guide. Data were collected for 5 months and analyzed with SPSS version 25. Qualitative data were analyzed using themes. Results: The explored significant challenges by stakeholders and nurses to sustainability of standardized nursing care plan (SNCP) in all the selected hospitals were inadequate knowledge of standardized nursing languages (SNLs), inadequate staffing, lack of motivation, lack of mandate to use SNLs by the educational system, lack of computers on the wards, weakness of previous training on SNL/SNCP, lack of interest, and high patient load. Conclusion: The study concludes that inadequate knowledge of SNLs and inadequate staff could contribute to non sustainability of SNCP. Implications for nursing practice: Nurses should be continuously trained on standardized nursing languages. Staff motivation and increasing the number of staff on the wards would increase the interest of the nursing staff. This will in turn improve the quality of documentation and patient care. [ABSTRACT FROM AUTHOR]

This study examined the predictive role of emotional reaction to pain on depression and investigated if there are significant age differences in depression among people living with sickle cell disease. A cross-sectional design carried out at Obafemi Awolowo University Health Centre (OAUHC) in Osun State, Nigeria, was conveniently used to select 71 respondents (females = 70.4%), with a median age of 19 years (SD = 5.94). Beck Depression Inventory (BDI) and Short-Form McGill Pain Questionnaire (SF-MPQ) were used to collect data from the respondents from 11 January to 15 February 2019. Simple linear regression analysis revealed that emotional reaction to pain significantly predicts depression among individuals living with sickle cell disease (R2 = 0.16, F(1, 69) = 16.70, p <.05)). One-way ANOVA results also showed a significant influence of age on depression (F(2, 68) = 4.439; p <.05)). The study concluded that emotional reaction to pain and age play significant roles in depression among people living with sickle cell disease in the study setting. [ABSTRACT FROM AUTHOR]

Background Human immunodeficiency virus (HIV) viral load (VL) monitoring is critical for antiretroviral therapy (ART) management. Point-of-care (POC) VL testing has been reported to be feasible and preferred over standard-of-care (SOC) testing in many low- and middle-income country settings where rapid results could improve patient outcomes. Methods The timeliness of receipt of VL results was evaluated in an open-label, randomized, controlled trial among patients newly initiating ART. Clinical outcomes with POC VL monitoring using Cepheid Xpert vs SOC VL at Jos University Teaching Hospital and Comprehensive Health Centre Zamko in Nigeria were assessed. We determined time between specimen collection and recording of VL in patient charts, receipt of results, and ART switch for those who met virologic failure criteria. Results Between April 2018 and October 2019, we screened 696 ART-naive individuals; 273 were randomized to POC and 268 to SOC HIV-1 VL testing. Participants in the POC arm received VL results significantly faster than those in the SOC arm (0.1 median days, interquartile range [IQR], 0.1–0.2 vs 143.1 days, IQR, 56.0–177.1, respectively; P <.0001). Participants in the POC arm with confirmed virologic failure vs those in the SOC arm were switched more rapidly to a second-line regimen (0 median days, IQR, 0–28 vs 66 days, IQR, 63–123, respectively; P =.03). Conclusions POC VL testing resulted in significant improvement in the timeliness of VL result receipt by patients and use for effective HIV clinical management. In patients experiencing VL failure, POC monitoring enabled prompt switching to second-line ART regimens. Clinical Trials Registration NCT03533868. [ABSTRACT FROM AUTHOR]

Background Lassa fever is endemic in large parts of West Africa. The recommended antiviral treatment is ribavirin. Two treatment regimens are currently endorsed in Nigeria: the "McCormick regimen" based on a study published in 1986 and the "Irrua regimen" constituting a simplified schedule developed at the Irrua Specialist Teaching Hospital, Nigeria. Evidence for the safety and efficacy of ribavirin in Lassa fever patients is poor and pharmacokinetic data for both regimens are lacking Methods Polymerase chain reaction-confirmed Lassa fever patients with mild to moderate disease severity were invited to participate in this prospective, observational pharmacokinetic study. Pharmacokinetics of ribavirin, clinical, virologic, and clinical laboratory parameters were assessed. Results Using a population pharmacokinetic approach, plasma concentrations of ribavirin were best described by a 3-compartment model. Drug exposure was remarkably consistent between participants. Overall, drug clearance was 28.5% lower in female compared with male participants. Median (5th-95th percentile) time above half maximal inhibitory concentration (IC50) was 37.3% (16.9%–73.1%), 16.7% (8.2%–58.5%), and 9.6% (4.9%–38.4%) on days 1, 7, and 8, respectively. Clinical laboratory parameters indicated reduction of cell damage and development of hemolytic anemia in the course of the treatment period. Conclusions This observational study characterizes the pharmacokinetics of ribavirin in the treatment of Lassa fever indicating consistent exposure across patients. Whereas only a short time interval of concentrations above the IC50 implies rather low antiviral efficacy in vivo, the prominent reduction of cell damage markers might point to indirect—potentially anti-inflammatory—effects of ribavirin. The role of ribavirin in the treatment of Lassa fever requires further scrutiny. [ABSTRACT FROM AUTHOR]

The study investigates if physical libraries are popular for research by students in the internet age post COVID-19. The study used a descriptive survey research design. The population consisted of 3457 Adeleke University undergraduates. Descriptive statistic was used to analyze data. The findings suggested that physical libraries are increasingly less popular among students for research purposes, owing mostly to the development of the internet era. Other reasons cited include physical library congestion and excessive surveillance, a preference to read with friends outside of the physical library, and a lack of motivation to visit the physical library. It was also discovered that students have a culture of completing their own research rather than paying professionals to do it for them. The study concluded that physical libraries are less popular for research among students, majorly due to the popularity of the internet. As a result, the study recommends that library management make physical libraries the strongest internet hub on campus, where all students would want to come for research. More efforts should be made to expand physical libraries and provide a variety of quiet reading options for those who detest crowds. [ABSTRACT FROM AUTHOR]

Background: Availability of adequate, timely and accurate information on patients' health records in line with standard procedures is critical for enhanced accessibility and utilization of relevant information for successful patients' care. Poor records documentation and management practices adversely affect the quality and effective utilization of health information with negative consequences on healthcare delivery outcomes. The study aimed to examine the health information management practices among health records personnel in two teaching hospitals in Nigeria, for best practices and the extent of alignment to established standards. Methods: The study adopted descriptive cross-sectional survey to examine the procedure for health records documentation and management in the two facilities. A semi-structured questionnaire was used to collect relevant information from respondents, selected by stratified proportionate random sampling technique, to answer the study questions on health records documentation and management practices and the extent of conformity to Standard Operating Procedures (SOPs), established by the Nigerian regulatory body. Data were collected and analyzed using descriptive and inferential statistics. Any procedure that scored below a criterion mean of 2.5 is considered substandard. Level of significance was set at 5%. Results: A total of 142 respondents completed the questionnaires. Ages range from 20-56 years with majority (67.6%) as females. Less than half (44%) of the respondents could use information technology applications adequately, while only a few (21.8%) have undergone specialized training in health information management (HIM). More than half of the respondents (53.5%) do not have requisite qualifications in HIM, lacking opportunities for in-service training. The institutions operate mostly paper-based/manual system of health records documentation and management with unitary system of filing. A number of the procedures scored below the criterion mean of 2.5 indicating significant underperformance below acceptable standards especially at ESUTH. These include; Disease and procedure indexing (2.0); identification and reporting of notable diseases (2.13), attaching of deficiency slip to folder without discharge summary (2.38); weeding of inactive records (2.5); and referring for consultative services (2.5). Conclusion: The study revealed sub-optimal performances in HIM practices among the health records personnel in the study facilities, with gaps in knowledge, infrastructure, policy and practice which is expected to negatively impact healthcare delivery. Findings underscore the need for engagement of qualified professionals, regular in-service training of health records staff as well as expanded use of electronic system in the facilities for enhanced flow of quality HIM, among addressing other identified deficiencies, for efficiency in health service delivery. [ABSTRACT FROM AUTHOR]

Introduction: Adequate nutrition plays a major role in delaying disease progression and improving quality of life of people living with human immunodeficiency virus (PLHIV). Therefore, it is important to assess their nutrition knowledge and practice of dietary diversity, especially in resource-limited settings, where most HIV infections occur. Aim of the study was to assess the nutrition knowledge and dietary diversity practice of PLHIV in a resource-limited setting. Material and methods: This was a health facility-based cross-sectional analytical study conducted at two tertiary HIV clinics in Enugu, Nigeria. Using a systematic random sampling technique, 370 adult HIV patients were recruited. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with good nutrition knowledge and high dietary diversity among respondents. P-value < 0.05 was considered statistically significant. Results: Good nutrition knowledge was observed in 69.7% of the respondents, while 60.0% had high dietary diversity. In multivariate analysis, secondary educational level (AOR: 0.54; 95% CI: 0.29-0.97; p = 0.040) and earning a family monthly income of 31,000-60,000 (AOR: 2.12; 95% CI: 1.11-4.06; p = 0.024) were predictors of good nutrition knowledge. Number of children in a household (AOR: 2.09; 95% CI: 1.19-3.67) was predictive of high dietary diversity. Conclusions: Educational level and family monthly income are predictors of nutrition knowledge, while number of children in a household is a predictor of dietary diversity. Nutrition education should be incorporated into HIV care program targeting those with low educational levels and low family monthly incomes for improvement of their nutrition knowledge. [ABSTRACT FROM AUTHOR]

Health screening exercises are important, as they enable early detection of diseases in individual subjects and also enable data collection, useful in estimating disease burden in the community. This paper describes the findings of a health screening exercise conducted in a semiurban population of Iloye, by the Rotary Club of Ota, Ogun State, Western Nigeria, as a part of its community-oriented services and projects. Three hundred and twenty six community members were screened during the exercise. There were 189 (57.97%) females and 137 (42.03%) males, with a mean age of 43.5 ± 14.88 yrs. Urinary abnormality and/or creatinine clearance less than 90 mls/min was detected in 147 (45.09%) participants. 99 (30.37%) participants had proteinuria, 16 (4.91%) had haematuria, and 5 (1.53%) participants had both haematuria and proteinuria. Eight (2.45%) participants had GFR less than 60 mls/min. Elevated blood pressure was found in 152 (46.63%), while 3 (0.9%) participants had diabetes, 71 (21.8%) were obese, 16 (4.9%) had hypercholesterolaemia, and 3 (0.9%) had hypertriglyceridaemia. Prevalence of both smoking and alcohol consumption was 6 (1.84%). It was concluded that the prevalence of indices of kidney damage and cardiovascular risk factors is high in Iloye community. [ABSTRACT FROM AUTHOR]

Background: With Nigeria being one of the countries with the highest neonatal mortality rate globally, identifying the risk factors associated with neonatal mortality is essential as we strive to proffer sustainable solutions.Aim: This retrospective hospital-based survey aimed to bridge this gap by evaluating the trends and risk factors associated with neonatal mortality in a teaching hospital in Southwestern Nigeria.Methods: Records of newborns admitted at the special care baby unit from January 2018 to December 2019 (n = 1098) were accessed, and available data were extracted. Descriptive analysis and inferential statistics were performed at 0.05 level of significance.Results: The mortality rate was determined to be 16.9% (inborn babies- 12.9% and out-born babies- 22.3%), with 83.3% of the newborns dying within the first week. Some of the factors associated with neonatal mortality were proximity of newborns' mothers home to the hospital [p = 0.041; Odds Ratio (OR) = 0.670; 95% Confidence Interval (CI) = 0.455-0.985], maturity of the baby at delivery (p < 0.001; OR = 0.514; CI = 0.358-0.738), place of delivery-inborn or out-born (p < 0.001; OR = 0.515; CI = 0.375-0.709), place of delivery-in a hospital or a non-hospital setting (p = 0.048; OR = 0.633; CI = 0.401-0.999), and baby's weight (p < 0.001; CI = -0.684 to -0.411).Conclusion: Findings from the study indicate that newborns delivered at home, traditional birth attendant centres or hospitals without essential healthcare facilities have a higher mortality risk. This suggests that measures to improve the accessibility of pregnant women to essential healthcare services are a prerequisite to reducing the neonatal mortality rate in Nigeria. [ABSTRACT FROM AUTHOR]

Cervical cancer is the second most common cancer in women. It is preventable if detected early. Effective screening can detect the earliest stage of premalignant form. This study was carried out to ascertain the knowledge and attitude of female students in four tertiary institutions in Imo State towards cervical cancer and its screening. Interviewee administered close-ended structured questionnaire was used for data collection. Questionnaires were validated by content and construct validity. A total of 400 female students in tertiary institutions within reproductive age; 16–45 years were recruited as respondents. Of the respondents, 398 (99.5%) completed and returned their questionnaires. These were analyzed using simple statistical methods. Results revealed that 350 (87.9%) have heard of cervical cancer while 265 (66.6%) have heard of cervical screening. Sexually active respondents were 186 (47%) meanwhile only 17 (4.3%) had undergone the screening. Most (93.5%), agreed that having multiple sexual partners was a risk factor. Most respondents (96.2%), knew that Human Papillomavirus (HPV) is the causative agent. The most prevalent (94%) reasons for not undertaking the screening was embarrassment followed by stigmatization 320 (80.4%). This study revealed high knowledge of cervical cancer among the students but poor attitude towards its screening. This calls for continued enlightenment for women of reproductive age including students in tertiary institutions on routine screening for cervical cancer especially as soon as they become sexually active. This will expectedly, increase the rate of early detection and subsequent treatment thereby preventing the high cost of treating and managing full-blown cervical cancer. [ABSTRACT FROM AUTHOR]

Rationale, Aims, and Objectives: Inappropriate prescribing is associated with preventable morbidity and mortality in the elderly. The American Geriatrics‐Beers (AGS‐Beers) Criteria was developed to guide healthcare professionals (HCPs) to prescribe medications appropriately in the elderly. However, there is a dearth of information about the knowledge and awareness of HCPs of these criteria, and their perceptions of appropriate prescribing in the elderly. This study aimed to evaluate the knowledge and perceptions of Nigerian and South African HCPs about appropriate prescribing in the elderly. Method: A 32‐item questionnaire was self‐administered among consecutively selected HCPs (physicians, nurses, and pharmacists) in one teaching hospital each in Nigeria and South Africa. Seven questions including six clinical vignettes from the 2015 AGS‐Beers Criteria were used to assess the participants' knowledge.The participants' knowledge was classified based on the total score as poor (0‐3), fair (4, 5), and good (6, 7). The HCPs' perceptions of appropriate prescribing in the elderly were evaluated using a 5‐point Likert scale. Mann‐Whitney U test was used to evaluate ranked variables at P <.05. Results: A total of 369 participants, 62.9% (232/369) mean age 42.75(9.35) years in Nigeria and 37.1% (137/369), mean age 38.66 (7.76) years, (CI = 2.32‐5.87, P <.001) in South Africa were evaluated. Many participants in Nigeria (52.6%) and 48.2% in South Africa had scores (4, 5).The majority of the participants (57.3%) in Nigeria and 67.2% in South Africa were not aware of any explicit criteria for prescribing to the elderly while 45.8% of the total participants with no significant difference between the groups (P =.332) "strongly agreed" or "agreed" that the basic professional training is adequate for prescribing medicines to the elderly. Conclusions: Many HCPs in Nigeria and South Africa had a fair knowledge of appropriate prescribing to the elderly and considered basic professional training as adequate for appropriate prescribing to the elderly. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to describe the prevalence of undernutrition in hospitalised infants aged under 6 months and test the utility of simple index measures to detect undernutrition.Design: Diagnostic accuracy study: weight, length, mid-upper arm circumference (MUAC), triceps and subscapular skinfolds were measured in infants aged 2 weeks to 6 months admitted to a Teaching Hospital in Enugu, Nigeria. Index criteria : low (<-2SD) weight-for-age Z-scores (WAZ), weight-for-length Z-scores (WLZ); MUAC <11 cm. Reference definition: weight faltering (conditional weight gain below fifth percentile for healthy Nigerian infants) or sum of skinfolds (SSF) <10 mm.Results: Of 125 hospitalised infants, only 5% (6) were admitted specifically for undernutrition, but low SSF were found in 33% (41) and, 24% (25) with known birth weight had weight faltering, giving an undernutrition prevalence of 36%. Low WAZ was the most discriminating predictor of undernutrition (sensitivity 69%, positive predictive value 86%, likelihood ratio 5.5; area under receiver operator curves 0.90) followed by MUAC (73%, 73%, 4.9; 0.86), while WLZ performed least well (49%, 67%, 2.9; 0.84). Where both MUAC and WAZ were low, there was sensitivity 90%, positive predictive value 82% and likelihood ratio 8.7.Conclusions: Infants aged under 6 months admitted to hospital in Nigeria had a high prevalence of undernutrition. In young, high-risk population, a low WAZ alone was a valuable screening criterion, while combining weight with MUAC gave even higher discrimination. Measurement of length to calculate WLZ was a less useful predictor in this population. [ABSTRACT FROM AUTHOR]

Objective: Public stigma against mental illness is well studied. However, there is a dearth of research into health workers' attitude towards children and adolescents with mental illness, especially in low- and middle income countries such Nigeria. Methods: A cross-sectional study was conducted among 395 health workers in a Teaching Hospital in North-Central Nigeria. Participants were selected by random sampling from clinical and non-clinical departments. Participants completed questionnaires to assess stigma, knowledge, personal contact, previous training, and exposure to religious teaching on child and adolescent mental illness (CAMI). Results: The response rate was 90%. Many health workers (42%) indicated that affected children should not play with other children, 38% would feel ashamed if a child in their family had mental illness, 42% would be concerned if their child sat with an affected child, and 27% would be afraid to speak to a child or adolescent with mental illness. Independent predictors of negative attitudes were: poor knowledge, exposure to religious teaching that affected children are possessed or dangerous, and being from a non-medical professional group. Conclusion: CAMI is stigmatised by health workers in this specialist Hospital in Nigeria. Urgent intervention is required to avoid adverse impact on affected children. [ABSTRACT FROM AUTHOR]

Background. Lassa fever outbreaks are common in Nigeria. The study aimed to assess knowledge, misperception, preparedness and barriers towards Lassa fever among health care workers (HCWs) in a tertiary hospital in Enugu. Methods. A descriptive cross-sectional study among 400 HCWs of a Teaching Hospital in Nigeria. Results. The study showed that 56.5% had fair knowledge while 42.0% and 1.5% had poor and good knowledge, respectively. Over 84% had good risk perception of acquiring Lassa fever while 15.8% had poor risk perception. Only 13% received training on emergency preparedness while 90.3% desired this training. Associations between occupation and knowledge were significant. Barriers to Lassa fever control were non-availability of infection control tools, lack of training on preparedness, absence of local laboratory, and non-availability of ribavirin. Conclusion. The study showed poor level of preparedness for Lassa fever and recommended routine training of HCWs on emergency preparedness. [ABSTRACT FROM AUTHOR]

Background: The delivery of effective inter professional co-operations in health practice is essential for successful treatment outcomes. Inter professional education has been seen to be a major means of improving the knowledge of students about other health disciplines and encouraging future co-operations in health practice. The study therefore aims at investigating health sciences students' knowledge and perceptions of physiotherapy, to enable the planning of a relevant interdisciplinary curriculum that includes all clinical students. Method: A total of 404 undergraduate clinical students [Males = 219, Females =185] in various health programmes participated in this study. A cross-sectional design was utilized for the study. A convenience sampling technique was utilized. Copies of the questionnaire were self-administered and data collected on the same day. The questionnaire was distributed in lecture halls and students' hostels and students were expected to respond to the sections bordering on their socio-demographics, knowledge and perception of physiotherapy. Descriptive statistics using frequencies and percentages was used to analyse data on knowledge and perception of physiotherapy. Results: A low level of knowledge of physical modalities and treatment procedures utilized by physiotherapists was observed across the various health care disciplines. A positive perception of physiotherapy was observed. Classroom lectures was identified as the most common source of knowledge of physiotherapy. Conclusion: A low level of knowledge of the various physiotherapy treatment procedures and modalities was observed among clinical students in the various health care disciplines. An improved interdisciplinary curriculum in the various colleges of medicine may foster the increase in knowledge of physiotherapy, hence promoting interdisciplinary health care. [ABSTRACT FROM AUTHOR]

Background: High nurse-patient ratios are burdensome for nurses and seem to be associated with shift work disorder. This study determined nurses' workload using nurse-patient ratios as indexes and examined the influence of workload burden on shift work disorder (SWD) among nurses. Methods: An ex-post facto design was utilized and was conducted in selected tertiary hospitals in Southwestern Nigeria. A multistage sampling technique was used to select 422 respondents. A structured questionnaire was used to collect data. Data was analyzed with SPSS Version 20. Results Mean of respondents working on the wards was 13 ±5.1; the average nurse-patient ratio was 1: 8 ± 6.4. Prevalence of symptoms predictive of SWD was (49.6%). More than half of the nurses (55.9%) had high workload, while (44.1%) had low workload. Workload was significantly associated with insomnia (χ² = 7.07, p = 0.001), and sleepiness (χ²= 5.77, p = 0.01) among nurses. Conclusion: The study concluded that nurses who had more patients to care for had more symptoms predictive of shift work disorder. [ABSTRACT FROM AUTHOR]

Purpose: This study assessed awareness and availability of assistive facilities in a Nigerian public university. Methods: Study was conducted in Obafemi Awolowo University (OAU), Ile Ife Nigeria using a mixed methods approach. Fifty two students with disability (SWD) were interviewed with a semistructured, self-administered questionnaire. A checklist was used to assess assistive facilities on campus while in-depth interviews (IDI) were conducted with university officials, to assess their perspectives about the availability and use of assistive facilities in the university. Results: Almost three-thirds (57.7%) of SWD were male while more than two-thirds were aged between 21 and 30 years. About seven in 10 (71.1%) respondents, had mobility impairment, while two-fifth had visual impairment (40.8%) and a few had hearing impairment. Only the university's administrative building had a functioning elevator. Slightly more than half (54.5%) of the lecture theatres have public address systems, while only two have special entrances and exits with ramps for SWD. Almost all respondents were unaware of facilities that aid learning (96.2%) and facilities for library use (90.4%). University officials were aware of assistive facilities for SWD but do not know the actual number of SWD. Conclusion: Assistive facilities for SWD on campus are limited. More assistive facilities need to be provided alongside increased awareness about these facilities and a disability register should be open for students on campus. Assistive facilities to aid learning and make SWD more comfortable are required. Universities should have an official policy on students with disabilities and implement it, such a policy should address special considerations for disabled students, such as having an updated register for students with disability, having examination questions in large fonts for students with visual disabilities, giving them extra time for examinations and providing special counselling services for students with disabilities. Awareness about assistive facilities in tertiary institutions for students with disability should be increased so that they can utilize the ones available and demand for such if non-existent. The design of buildings on university campus should be made disability friendly. A disability register should be open for SWD on campus. [ABSTRACT FROM AUTHOR]

Background: Unethical behavior among nurses is gradually becoming a severe problem in the health sector of Nigeria, and this calls for urgent concern. However, it may be associated with issues inside healthcare organizations. Therefore, this study aimed to investigate the relationship between role ambiguity, organizational justice, and unethical behavior among nurses. Methods: This was a cross-sectional study. In total, 300 participants were selected from Lagos State Teaching Hospital (LUTH) in Lagos metropolis using a convenience random sampling method. A structured questionnaire consisting of demographics and Unethical Behavior Scale (UBS), Role Ambiguity Scale (RAS), and Organizational Justice Scale (OJS) was used to collect the required data. Multiple regression model was used to analyze the obtained data in SPSS. Results: Among the subjects, 71.9% were females, and 28.1% were 99 males. Their age ranged from 24 to 57 years Mean±SD: 31.66±3.13. There was an independent relationship between role ambiguity and unethical behavior (ß=0.229; t=3.157; P<0.05). Additionally, there was an independent relationship between organizational justice and unethical behavior (ß=-0.317; t= -2.182; P<0.05). Conclusion: Role ambiguity and organizational justice predicted unethical behavior. Therefore, the authorities and hospital managers of Nigeria should design an intervention program tailored for resolving role ambiguity and improving organizational justice. This will help to reduce the menace of unethical behavior among these nurses. [ABSTRACT FROM AUTHOR]

Background: Many studies on transcutaneous electrical nerve stimulation (TENS) had been undertaken to explore its pain relieving efficiency on several medicals/surgical conditions but none, specifically, had been carried out to determine the effect it has on post-injection sciatic pain (PISP) which comes about from wrong administration of intramuscular pain. This study aims to assess the effects of TENS in the management of PISP. Methods: A total of 72 PISP subjects comprising 40 test subjects and 32 control subjects participated in a non-randomized controlled clinical trial in the current study. Participants were recruited from Department of Physiotherapy, Nnamdi Azikiwe University Teaching Hospital, Nnewi and Landmark Physiotherapy Services, Nnewi. The participants were however blinded to the intervention method they will receive before being allotted conveniently to test/experimental group (TG) or control group (CG). A written informed consent was obtained from participants before enrollments in the study. TENS and sham TENS (STENS) was applied to 40 test and 32 subjects respectively, 3 times a week, and 1 hour per session for the 10 weeks the study lasted. The Visual Analogue Scale was used to collect baseline data as well as those of 2nd, 4th, 6th, 8th and 10th weeks after TENS and STENS interventions. The data analysis was performed with the Descriptive statistic of Mean ± SD, mean comparison test, repeated analysis of variance and paired wise t-test. Statistical level of significance was set at P < 0.05. Result: Results of repeated measure ANOVA showed that the pain level among participants in the treatment group at the end (after 10 weeks) of the intervention was significantly lower than that of their counterparts in the control group (F = 16.26; p = 0.01); with the intervention accounting for the 19% of the variance. The effect size (partial eta squared) = 0.19. Conclusion: The outcome of this research has proved the effectiveness of TENS in the management of PISP and is being recommended in the management of PISP. Trial registration: Pan Africa Clinical Trial Registry (PACTR201805003408271). The study was registered retrospectively on the 29th May, 2018. [ABSTRACT FROM AUTHOR]

Background: Beta (β)-endorphins are endogenous neuropeptides found in the plasma and cerebrospinal fluid (CSF) of humans but there have been reports of the relationship between the plasma and CSF β-endorphin levels in different clinical conditions. However, the relationship between β-endorphin levels in the plasma and CSF of children with cerebral malaria (CM) has not been reported. Aim: To determine the relationship between β-endorphin levels in the CSF and plasma of children with CM. Settings and Design: This cross-sectional study involved 40 children, aged between 6 months and 14 years, admitted with a diagnosis of CM at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria. Materials and Methods: One milliliter (mL) of venous blood and 1mL of CSF obtained from each subject at admission were used to determine the β-endorphin levels using enzyme-linked immunosorbent assay (ELISA) method. Statistical Analysis: Bivariate linear regression was used to determine the association between plasma and CSF β-endorphin levels using the correlation coefficient (r), coefficient of determination (R2), and P values. Results: The plasma β-endorphin levels significantly positively correlated with CSF β-endorphin (r = 0.568, P = 0.001) such that for every unit rise in plasma β-endorphin, CSF β-endorphin rose by 0.252 pmol/L (confidence interval: 0.132–0.371 pmol/L). Conclusion: The finding of positive correlation between plasma and CSF β-endorphin levels in this study suggests a possible direct link between plasma and CSF in CM, probably from the disruption of the blood–brain barrier that has been reported in CM. [ABSTRACT FROM AUTHOR]

Purpose: The study seeks to assess the care needs of oncology in‐patients and clinic attendees or families in two tertiary health institutions. Methods: This was a descriptive study which utilised a quantitative survey questionnaire of all cancer patients diagnosed between January 2014 and September 2016 (n = 547) with the return rate (n = 455) representing 82%. The questionnaire explored assessment of palliative care need. These instruments were used, because patients with cancer and their families are reluctant to talk about the disease. Using a questionnaire was therefore the best means of obtaining their full participation. The data were analysed using descriptive statistics to identify the highest need of patients with cancer patients. The study was approved by the two participating hospitals and the Human and Social Sciences Research Ethics of University of KwaZulu‐Natal. Findings: The study found that most common needs of patients were information on possibilities of treatment and side effects (92.8%), diagnosis (91.6%), testing (91.1%) and physical symptoms (90.9%). There were also other needs, such as psychological, spiritual and financial needs, related to factors causing distress to patients and their families following diagnosis of cancer. Conclusions: This article focused on needs as expressed by patients and families and offers a useful guide to develop a model for integration of palliative care activities. The findings reveal that patients who are undergoing follow‐up care and cancer treatment or investigation are clearly concerned about receiving information on a range of cancer issues. We therefore conclude that patients are able to deal with the disease more effectively when hospitals set up a palliative care team or unit to carry out proper assessment of patients living with cancer. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The study aimed to evaluate the effectiveness of antenatal perineal massage (APM) in reducing perineal trauma and post‐partum morbidities. Methods: A randomized controlled trial of 108 primigravidae at the University of Nigeria Teaching Hospital, Enugu, Nigeria, was conducted from January 2013 to May 2014. The intervention group received APM, while the control group did not receive APM. Results: Women who received APM were significantly more likely to have an intact perineum after childbirth [27/53 (50.9%) vs 16/55 (29.1%); RR: 1.75; 95% CI: 1.07–2.86; P = 0.02]. The incidence of episiotomy was lower in the intervention group [20/53 (37.7%) vs 32/55 (58.2%); RR: 0.65; 95% CI: 0.43–0.98; P = 0.03; NNT = 5]. Women who received APM were significantly less likely to develop flatus incontinence [4/53 (8.3%) vs 13/55 (26.0%); RR: 0.32; 95% CI: 0.11–0.91; P = 0.03]. However, the incidences of premature rupture of membranes, preterm labor and birth asphyxia were similar between the two groups (P > 0.05). Conclusion: APM reduces the incidence of episiotomy and increases the incidence of women with an intact perineum after vaginal delivery. It also reduces the risk of flatus incontinence after childbirth without increased maternal or neonatal complications. Women should therefore be counseled on the likely benefits of APM and the information provided during antenatal care. Obstetricians should consider the technique as routine prenatal care for nulliparous women so as to reduce the incidence of perineal trauma during vaginal birth. [ABSTRACT FROM AUTHOR]

Purpose:To investigate the impact of disability and sexual dysfunction on Health-Related Quality of Life (HRQoL) among Nigerian stroke survivors (SSv) and to determine their association using sexual functioning (SF), Global Disability Measure and Function (GDMF), and demographic profiles. Methods:This study involved 121 consecutive SSv attending healthcare services in two tertiary health facilities in Nigeria. Demographic details were obtained through interview while HRQoL, SF, and Global Disability (GD) were assessed using Stroke-Specific Quality of Life (SS-QoL-12), Changes in Sexual Functioning Questionnaire (CSFQ-14), and World Health Organization Disability Assessment Schedule (WHODAS-2.0), respectively. Determinants of HRQoL were explored using the Poisson regression analysis. Results:Most of the SSv had moderate/severe GD (95%) and low SF (86.8%). Their HRQoL decreased with increase in their age (p = 0.005) and with increase in GD (p = 0.001). This association remained unchanged even when adjusted for SF (p = 0.001). Those with low SF but with mild GD had relatively better HRQoL than those with moderate/severe GD even when they had higher SF. Their HRQoL was negatively impacted by their GD but not by their SF despite direct correlation between SF and HRQoL. With a unit increase in level of GD, there was 8% decrease in HRQoL scores in psychosocial and 17% decrease in physical domains. Conclusion:Although sexual dysfunction and global disability are prevalent among Nigerian SSv, their low HRQoL is determined by their disability and not by SF. Hence, effort at reducing global disability should be the focus of rehabilitation after stroke.Implication for RehabilitationGlobal functional and sexual deficiencies abound in stroke survivors and they impact negatively on their overall quality of life.Sexual dysfunction correlates negatively on physical and psychosocial wellbeing of stroke survivors.Rehabilitation goal(s) should focus disability reduction and improvement of sexual functioning to enhance quality of life.Rehabilitation professionals should equip themselves with tools to counsel stroke survivors on sex issue since sexual dysfunction is common post stroke. [ABSTRACT FROM AUTHOR]

Purpose: ST2 receptor, which is a member of the Toll-like/interleukin-1 (IL-1) receptor family, has been found to be increased in the serum of patients 1 day after myocardial infarction. Several other studies have shown that soluble ST2 levels correlate with severity of heart failure (HF), left ventricular ejection fraction, creatinine clearance, B-type natriuretic peptide and C-reactive protein, and are predictors of mortality in HF. Most of these studies were not only limited to ischemic heart disease but also concentrated on left-sided HF. We therefore decided to study the relationship between soluble ST2 and some markers of right ventricular (RV) function in a cohort of hypertensive HF subjects.Patients and Methods: This is a prospective cohort study of hypertensive HF patients presenting to the University of Abuja Teaching Hospital, Abuja, over a 12-month period. ST2 was measured in plasma sample by the enzyme-linked immunosorbent assay (ELISA) method. Right ventricular diameters in diastole (RVDD) and right atrial area (RAA) were obtained on echocardiography, while right ventricular systolic pressure (RVSP) was estimated from echocardiography by the addition of the pressure gradient between the right ventricle and right atrium (RA) to the pressure in the RA.Results: There was a significant correlation between RVSP and soluble ST2 (t=0.75, p<0.0001), RVDD (t=0.28, p=0.004) and RAA (t=0.46, p=0.002).Conclusion: In a cohort of hypertensive HF subjects, soluble ST2 correlates significantly with RVSP, RVDD and RAA. [ABSTRACT FROM AUTHOR]

Purpose: The study investigated the level of adherence and factors affecting adherence to antiretroviral treatment (ART). Methods: The study sample consisted of 300 HIV-infected patients who received ART in the Antiretroviral Clinic of Central Hospital, Agbor, Delta State, Nigeria. Self-reported adherence to ART in the previous 1 month prior to the study as well as determinants of adherence were assessed using a questionnaire. Results: The most frequently used ART regimen was zidovudine + lamivudine + nevirapine. On the whole, a total of 33 (11%) respondents missed 3 doses or less in the previous month prior to the survey. There was a statistically significant association between adherence to ART and marital status, source of income, and occupation (P < .05). The most commonly reported reasons for missed doses were forgetfulness (60.4%), busy daily task (18.3%), and avoiding being seen while taking medications (11%). Conclusion: The prevalence of adherence among the participants was high. However, more serious efforts are needed to reduce the number of in-adherent patients. Interventions to improve adherence to ART should address challenges such as forgetfulness among the patients and frequent occurrence of adverse effects and consider specific patient-related factors such as daily tasks. [ABSTRACT FROM AUTHOR]

Healthcare experiences among women living with HIV/AIDS (WLHA), determine their utilisation of sexual and reproductive health services, which ultimately influences their decisions on childbearing. This study aimed to understand the importance of healthcare support in the childbearing decision-making processes of WLHA, and its impact on eliminating new paediatric HIV infections. We conducted in-depth interviews between July and August 2012 with 15 WLHA receiving clinical HIV care at a teaching hospital in Lagos. Using PEN-3 cultural model, as a guide we explored perceptions of healthcare support pre- and post-partum. Findings indicate that faith in God for the delivery of a healthy child is significant during the pre-partum period, while the advice of healthcare workers concerning childbearing and access to available healthcare services carry more weight post-partum. Our findings have important implications for HIV treatment and care programmes geared towards WLHA considering childbearing, and ultimately the UN Global plan to eliminate mother-to-child transmission of HIV, as we move towards the 2030 agenda for sustainable development. [ABSTRACT FROM AUTHOR]

Presence of psychological distress and poor quality of life (QoL) may affect the outcome of HIV/AIDS. One hundred and seventeen consecutive and consenting participants were interviewed using a Socio-demographic questionnaire, Kessler Psychological Distress Scale (K10) and World Health Organization Quality of Life-HIV Bref. Fifty-six (47.9%) participants scored 20 and above on K10 Scale. QoL was significantly higher in married participants, those who perceived their state of health as being good, asymptomatic participants and those who scored well–mild on K10. The older age group scored higher on QoL Scale than the younger age group in the physical health domain while the married participants scored higher in the domains of physical health, psychological health, environment and spiritual/religion. The participants who perceived their state of health as being good scored higher than those who perceived their health as poor in all domains. There is a high level of psychological distress and poor QoL in people living with HIV/AIDS. [ABSTRACT FROM PUBLISHER]

Aim. To assess the impact of caries and its treatment on quality of life (QoL) in 12- to 15-yearold children in Benin, Nigeria. Design. This was a cross-sectional study involving 1790 children. Clinical examinations were conducted using the WHO criteria for diagnosis and coding of caries. The Decayed Missing Filled Teeth score of each child was calculated. The child Oral Impact on Daily Performance questionnaire was used to assess the QoL of children with caries preand post-treatment. Associations between age, sex, and socio-economic status and caries were analysed using bivariate and multivariate logistic regression analysis. Results. The prevalence of caries in the study population was 21.9%. Approximately 57% of children with caries reported negative impact on their QoL pre-treatment. Eating (47.6%) was the most affected domain. The mean pre-treatment QoL score was 8.40 ± 10.34. Four weeks posttreatment, only 1.12% of participants reported negative impact of caries treatment on their QoL. The mean post-treatment QoL score was 0.22 ± 0.91 There was a significant difference between pre- and post-treatment QoL scores (P = 0.0001) with significant changes in all the eight domains studied. Age, sex, and socio-economic status had no significant impact on QoL pre- and post-treatment. Conclusions. Caries had a significant impact on the QoL of adolescents. Its treatment resulted in marked improvement in QoL. [ABSTRACT FROM AUTHOR]

The first six months of HIV care and treatment are very important for long-term outcome. Early mortality (within 6 months of care initiation) undermines care and treatment goals. This study assessed the temporal distribution in baseline characteristics and early mortality among HIV patients at the University College Hospital, Ibadan, Nigeria from 2006–2013. Factors associated with early mortality were also investigated. This was a retrospective analysis of data from 14 857 patients enrolled for care and treatment at the adult antiretroviral clinic of the University College Hospital, Ibadan, Nigeria. Effects of factors associated with early mortality were summarised using a hazard ratio with a 95% confidence interval obtained from Cox proportional hazard regression models. The mean age of the subjects was 36.4 (SD=10.2) years with females being in the majority (68.1%). While patients’ demographic characteristics remained virtually the same over time, there was significant decline in the prevalence of baseline opportunistic infections (2006–2007=55.2%; 2011–2013=38.0%). Overall, 460 (3.1%) patients were known to have died within 6 months of enrollment in care/treatment. There was no significant trend in incidence of early mortality. Factors associated with early mortality include: male sex, HIV encephalopathy, low CD4 count (< 50 cells), and anaemia. To reduce early mortality, community education should be promoted, timely access to care and treatment should be facilitated and the health system further strengthened to care for high risk patients. [ABSTRACT FROM PUBLISHER]