Journal of Community Medicine & Primary Health Care

Implementation of Primary Health Care in Lagos Nigeria: An Assessment of Governance and Service Availability

K.O. Wright — 2024-08-15

Background: There is limited understanding of the role and effectiveness of community involvement and governance in enhancing primary healthcare (PHC) services. This study aims to assess governance structures and the availability of PHC services in Lagos State, Nigeria.

Methods: A cross-sectional study was conducted from November 2022 to January 2023, using a multi-stage sampling technique to select five Local Government Areas (LGAs) in Lagos State, Nigeria—Alimosho, Kosofe, Ojo, Epe, and Surulere—and four Primary Healthcare Centres (PHCs) per LGA. Data collection included health facility assessments and key informant interviews. Data analysis was conducted using SPSS and NVivo software. Ethical approval was obtained for the study.

Results: Most (84.2%) of the Primary Health Centres (PHCs) had active development committees that were involved in various activities, such as fixing service prices (100%), discussing administrative issues (42.1%), and managing facility repairs (31.6%). All PHCs offered family planning services, facility-based vaccination, and outreach-based vaccination programs. However, only 52.6% of the facilities offered essential obstetric care and labour and delivery services. Key informants emphasized their role in advocating for primary healthcare utilization and promoting community health initiatives. Challenges included low community participation due to the need for more financial incentives and unmet government promises.

Conclusion: PHC governance in Lagos State shows promising community engagement through active development committees, yet challenges persist. Improvements are needed in service availability, particularly in maternal and child health services and infrastructure. Strengthening governance structures is crucial for sustainable healthcare delivery and equitable health outcomes.

Assessment of Primary Healthcare Centres for Care of NonCommunicable Diseases in the Federal Capital Territory, Abuja, Nigeria

F.O. Anumah — 2024-08-15

Background: Non-communicable diseases are the world’s biggest killers with an upward trajectory in the deleterious effect on global health burden. The aim of this study was to assess the capacity of the primary healthcare centres (PHCs) in the Federal Capital Territory (FCT) to implement WHO Essential Package for NCDs (WHOPEN)

Methodology: This was a cross-sectional health facility-based survey conducted in 32 selected PHCs in the FCT. The WHO rapid assessment tool for primary healthcare facility capacity assessment for NCDs was adapted and used for data collection. Data was analysed using SPSS version 20. Approval for the survey was given by the Federal Ministry of Health.

Result: All the PHCs had at least 2 trained nurses and 6 community health workers. Also, 31% had medical officers while 71% had laboratory technicians. Basic equipment for NCDs such as weighing scales and sphygmomanometers were available but only about 50% of the PHCs had glucometers. Devices such as pulse oximeters, peak flow meters, nebulizers, electrocardiographic machines and blood cholesterol assay kits were unavailable. Oral antidiabetic drugs and insulin were not available in 60-90% of the PHCs. The most available anti-hypertensives were hydrochlorothiazide and alpha methyldopa. The prevalence of NCDs among the patients was 5.3%. Healthcare was financed by individuals and supported by the local government. None of the centres had a registry.

Conclusion: Critical gaps were identified in the management of NCDs in PHCs. This will provide the basis for the implementation of strategies to strengthen PHCs and make WHO-PEN implementable in low-resource settings.

Profile of Intentional Self-Poisoning Cases among Adolescents at the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria – A 2-year review

A.O. Babatola — 2024-08-15

Background: Intentional self-poisoning (Deliberate self-poisoning) is fast becoming a major public health problem, especially among adolescents. The period of adolescence is tumultuous for some adolescents. This study describes the socio-demographic profile of adolescents managed for intentional self-poisoning at the Paediatric Unit of Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria

Methods: A retrospective descriptive study was conducted. The records of 10 adolescents managed for intentional self-poisoning from December 2021 to November 2023 were reviewed. Data extracted included age, sex, name of substances ingested, duration of admission and treatment outcome.

Results: There were 4(40.0%) males and 6(60.0%) females. The median age of adolescents with intentional self- poisoning was 15.0 years (interquartile range 13.0- 15.3 years). The agents ingested were organophosphate 5(50.0%), paraquat 3 (30.0%) and substances not documented 2(20.0%). The mean (standard deviation) duration of admission was 1.7 (1.06) days. Six (60.0%) were discharged, 1(10.0%) left against medical advice and 3(30.0%) deaths were recorded. All the 3 that died ingested paraquat. Most of the patients took the substances because they were reprimanded for ill behaviours and 2(20.0%) had associated diagnosed psychiatric disorders.

Conclusion: In this study, there were more females with intentional self-poisoning and the mortalities were in those that ingested paraquat. Campaigns on the prevention of poisoning, particularly among adolescents, should be intensified. In addition, enforcement of regulations on lethal herbicides and pesticides is recommended. Furthermore, the establishment of poison control centres will help significantly in improving the outcome of care and research about preventive measures.

Factors Influencing HIV Testing Uptake Among Adolescents in Selected Communities of Rivers State: A Cross-Sectional Study

V.I. Ogbonna — 2024-08-15

Background: Despite the availability of testing services, willingness to undergo HIV testing among adolescents remains low, posing barriers to effective prevention and treatment efforts. Our study assesses factors that influence HIV testing uptake among adolescents in selected communities in Rivers State, Nigeria.

Methods: A cross-sectional study design and a multi-staged sampling technique were used to survey 671 adolescents on the uptake of HIV tests using an intervieweradministered questionnaire. Data was analysed using IBM SPSS version 27. Bivariate analyses were conducted to assess the association between independent and outcome variables (HIV testing uptake). A multivariate logistic regression model was used to ascertain predictors adjusting for confounding. Ethical approval was obtained for the study.

Results: The median age of respondents was 18 years; about 356 (53.9%) were females, and 56 (8.3%) had no formal education. Less than half of the respondents, 296 (43.8%), have ever been tested for HIV. The factors that influenced HIV testing uptake were the level of education, marital status, and current school attendance. Specifically, those with tertiary and secondary education were 0.25 and 0.30 times less likely to have had an HIV test done (aOR=0.25, 95% CI: 0.17-0.37, p=0.001), and (aOR=0.30, 95% CI: 0.14-0.63, p=0.001) compared to those with no formal education.

Conclusion: About half of the respondents have never been tested for HIV. There is a need for stakeholders and the government to implement strategies that promote early and routine HIV testing and emphasise the importance of regular HIV testing as a preventive measure among adolescents.

Prevalence, Characterization and Predictors of Physical Workplace Violence among Doctors and Nurses in Public Hospitals of Akwa Ibom State, Nigeria

U.A. John — 2024-08-15

Background: Workplace violence (WPV) is currently a global phenomenon that is gradually becoming a public health concern in most work environments. This study aimed to assess and compare the prevalence, characterization and predictors of physical workplace violence among doctors and nurses in public hospitals of Akwa Ibom State, Nigeria.

Methodology: A comparative cross-sectional study was conducted from September to December 2021 involving the use of a self- administered questionnaire. Multi-stage sampling technique was used to select 230 doctors and 230 nurses from 10 public hospitals in the State. Data were analysed using descriptive and inferential statistics. The significance level was set at p<0.05 and the confidence interval at 95%.

Results: The prevalence of physical violence was significantly higher in nurses (24.8%) compared to doctors (10.4%) p<0.001. The main perpetrators of physical violence were patient relatives. Respondents from both professional groups reported the use of weapons by perpetrators to commit the act of violence (nurses-80.7% vs doctors79.2%). Predictors of physical workplace violence among the doctors included being male (OR=3.34, 95%CI=1.09-10.25) and working in the psychiatry unit (OR=11.62, 95%CI=2.65-50.94), while among the nurses, it included working in the psychiatry (OR=25.48, 95%CI=6.89-94.35) and emergency units (OR=5.44, 95%CI=2.11-14.06).

Conclusion: Safety at the workplace is an important prerequisite in guaranteeing quality service delivery and the best possible performance of the workforce. The high prevalence of physical violence in this study underscores the need for hospital management to develop and implement zero-tolerance policies to prevent violence in healthcare settings.

Stressors and Coping Mechanisms Employed by Undergraduate Medical Students in a Nigerian University

E.S. Aigbokhaevbo — 2024-08-15

Background: Medical education, characterized by intense stress, is rated as one of the most difficult trainings. This stress can be associated with consequences such as impaired academic performance and medical errors. The study assessed stressors medical students in a Nigerian tertiary institution are exposed to and their coping strategies.

Methods: A descriptive cross-sectional study was carried out from December 2021 to February 2023 among 611 undergraduate medical students in the School of Medicine, University of Benin, Nigeria, using a stratified random sampling technique. Data were collected using a semi-structured self-administered questionnaire adopting the brief Coping Orientation to Problems Experienced (brief COPE) and the Patient Health Questionnaire-4 (PHQ-4). Analysis was done using IBM SPSS Statistics Version 25 software, determining the frequency of occurrence of each stressor using univariate analysis and calculating the mean and standard deviation of each coping strategy to determine the least and most used ones. Ethical clearance was obtained for the study.

Results: The mean age of the respondents was 22.9 (SD ± 3.1) years, 326 (53.4%) were males while 285 (46.6%) were females. They were exposed to a myriad of academic, environmental, psychosocial and health-related stressors with the presence of complications of stress (depression; 17.0% and anxiety; 22.3%). Adaptive coping strategies most often employed were planning (5.01±1.90) active coping (4.99 ± 1.81) and religion (4.77± 2.07).

Conclusion: The undergraduate medical students are exposed to various stressors. A significant number of them had depression and anxiety. Continuous use of adaptive coping strategies will mitigate the harmful consequences of stress.

Prevalence, Pattern of Skin Diseases and Associated Risk Factors among Students of a Public Secondary School in Ekiti State, South-West Nigeria

O.O. Abioye — 2024-08-15

Background: Limited research exists on the frequency and patterns of dermatologic problems in adolescents and young adults. This study determined the prevalence and pattern of skin diseases and associated risk factors among students at a public secondary school in Ekiti State.

Method: A cross-sectional survey was conducted among 226 public secondary school students (Federal Teaching Hospital Staff School, Ido-Ekiti) Ekiti State, Southwestern Nigeria. The total population was used in this study using a semi-structured interviewer-administered questionnaire. Also, a general body medical examination was performed on the students to assess for skin lesions/rashes. Data collected were analysed with IBM SPSS version 25.0, while Chi-square and binary logistics regression were used to determine the predictors of skin diseases. Results with a p-value less than 0.05 were considered significant.

Result: The majority (86.5%) were 9 to 15 years old, with a male-to-female ratio of 1.03:1. The prevalence of skin diseases among the students was 50.7%. More than two-thirds (70.8%) of those with skin disease had one skin disease and the commonest skin diseases among the students were acne (26.0%), miliaria sweat rash (11.2%), and pityriasis versicolor (7.2%). The only predictor of skin disease among the children was awareness (AOR=2.236, 95% CI= 1.227 – 4.076) rather than unawareness of skin disease.

Conclusion: Over half of the students had one or more skin diseases, with acne and miliaria sweat rash being the most common forms. Awareness of skin diseases was a predictor of skin diseases among the participants. It is recommended that secondary school students may benefit from educational programs on the prevention of skin diseases.

HPV Vaccine and Cervical Cancer Screening Uptake among women in Abia State

C.I. Amuzie — 2024-08-15

Background: Cervical cancer is the fourth most common cancer in women, and it is associated with infection by the Human Papillomavirus (HPV). There are effective interventions for the prevention of cervical cancer. However, the uptake of these interventions by women in developing countries is poor. This study assessed the knowledge and practices of cervical cancer preventive measures and uptake of HPV vaccines among women in Abia State.

Method: This was a descriptive cross-sectional study among women in Abia State. Multistage sampling was used to recruit 700 eligible women and an ODK interviewerbased structured questionnaire was used to collect the information. Descriptive, bivariate, and multivariate analyses were done using SPSS version 26. The level of significance was set at 5%.

Results: The mean age of the respondents was 40.3 ± 9.9 years and the proportion of women with good knowledge of HPV infection and vaccine was 22.0% (95% CI: 18.9- 25.1). The uptake of Pap smear and HPV vaccine was 7% and 3%, respectively, while predictors of good knowledge for HPV infection and vaccine included higher educational status (aOR = 2.53; 95% CI: 1.73–3.71, p = 0.001), being currently married (aOR = 0.32; 95% CI: 0.18–0.54, p= 0.001) and divorced (aOR = 0.25; 95% CI: 0.13–0.49, p=0.001).

Conclusion: Poor knowledge of HPV infection and vaccines, and poor uptake of Pap smear and HPV vaccine were prevalent among the respondents. We recommend policymakers design health education programmes to improve knowledge and preventive cervical cancer practices.

Knowledge and Perception of Diphtheria among Residents of a Rural Community in Kaduna State, Northwest Nigeria

Z.S. Babandi — 2024-08-15

Background: Diphtheria has reemerged as a public health concern in Nigeria, with outbreaks reported across several states. Catch-up vaccination, enhanced surveillance, and risk communication were instituted to curb this. This study determined knowledge and perception of diphtheria among members of a rural community in Kaduna State, Northwestern Nigeria.

Methods: Using a cross-sectional descriptive study design, data were collected from 590 respondents drawn through multistage sampling. Composite knowledge and perception scores were computed and graded using median values as cut-off points for good knowledge and perception. The data was presented using descriptive statistics, while the chi-square test of independence was used to check for association between socio-demographic variables and outcome variables at p < 0.05.

Results: The respondents comprised 226 (38.3%) males and 364 (61.7%) females, with a mean age of 33.6 (+6.0) years. Only 117 (19.8%) respondents had ever heard of diphtheria. Among those aware of the disease, only 28 (23.9%) identified germs as causative agents, 26 (22.2%) identified inhalation as a route of transmission, 24 (20.5%) knew diphtheria could cause an epidemic, and 31 (26.5%) identified vaccine as a preventive measure. Most of the respondents (81.2%) had poor knowledge and good perception (68.4%). No statistically significant relationship was observed between sociodemographic variables and Knowledge or perception of Diphtheria.

Conclusion: While the perception of diphtheria was good, knowledge of the disease was poor despite an ongoing outbreak. The Kaduna State government should redouble efforts in community health education and strategic risk communication on diphtheria.

Appraising the Effects of Performance-Based Financing on Healthcare Service Utilization in Nasarawa State, Nigeria

M. Abdulkadir — 2024-08-15

Background: Performance-based financing (PBF) is an innovative approach that can potentially optimize the demand for facility-based care and services. This study aimed to appraise the effects of PBF on healthcare services utilization in Nasarawa State, Nigeria.

Methods: The study employed a cross-sectional design at three randomly selected PBF-benefiting Primary Healthcare Centres (PHCs). Using mixed methods, structured checklists and key informant interviews (KIIs) were utilized for data collection across three PBF program periods: at the beginning (2013), at the end (2020) and two years post-intervention. Facility attendance was examined using a Poisson Regression Model at p<0.05 level of statistical significance.

Results: Data from 25,025 facility users were analysed; most were females (72.0%), and aged 1-25 years (58.3%). Services utilized included out-patient care (33.3%), antenatal care (24.5%), postnatal care (15.4%). Facility attendance is statistically significant at the end of PBF intervention (Poisson regression coefficient [µ]= 1.2403, p=0.000) and two years post-intervention (µ=1.4564, p=0.000). The KII participants attributed the change to enhanced resources from the PBF project and reported that facilities are experiencing resource shortages and infrastructure issues that ultimately impact patient flow and service utilization; thus, they proposed the provision of additional human and material resources to address the challenges.

Conclusion: The study finds evidence for the positive effects of PBF on healthcare service utilization intra-intervention but not two years post- intervention. Future research is needed to determine the mechanisms for sustaining PBF intervention gains and explore factors contributing to the decline in service utilization post-intervention.