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   Table of Contents - Current issue
Coverpage
October-December 2022
Volume 29 | Issue 4
Page Nos. 281-353

Online since Thursday, October 27, 2022

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REVIEW ARTICLE  

The Nigeria national health insurance authority act and its implications towards achieving universal health coverage Highly accessed article p. 281
Tope Michael Ipinnimo, Kabir Adekunle Durowade, Christiana Aderonke Afolayan, Paul Oladapo Ajayi, Tanimola Makanjuola Akande
DOI:10.4103/npmj.npmj_216_22  
The National Health Insurance Scheme (NHIS) faced several inherent and systemic drawbacks towards achieving universal health coverage for all Nigerians, and this has led to the signing of the new National Health Insurance Authority Act (NHIA), 2022. This article highlights the benefits of NHIA, discusses the possible challenges and the way forward in its implementation. A narrative review of past literature searched in PubMed, MEDLINE, African Journal Online, and Goggle was conducted. A total of 76 publications were initially retrieved and following data triangulation, 55 were finally used. The authors also included their experiences. The NHIA addressed some of the shortcomings of the previous NHIS, however, it would still face several challenges in its implementation such as low government funding priority to health, shortage of healthcare workers and poor healthcare coverage, as well as problems with enforcement as it mandates all Nigerians to enroll. These and other impending constraints must be surmounted and all stakeholders must be involved to ensure the Act accomplishes its aim.
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ORIGINAL ARTICLES Top

Acceptability, appropriateness and feasibility of webinar in strengthening research capacity in COVID-19 era in Nigeria p. 288
Abiola Olubusola Komolafe, Omotade Adebimpe Ijarotimi, Olufemi Mayowa Adetutu, Oluseye Ademola Okunola, Temitope Olumuyiwa Ojo, Funmilola Folasade Oyinlola, Oluwatosin Eunice Olorunmoteni, Monday Daniel Olodu, Ojo Melvin Agunbiade, Olayinka Donald Otuyemi
DOI:10.4103/npmj.npmj_167_22  
Introduction: The challenges posed by the COVID-19 pandemic have necessitated the increasing use of online virtual training platforms. The objectives of the study were to assess the acceptability, appropriateness and feasibility of virtual space in strengthening the research capacity in Nigeria. Materials and Methods: Data were collected through an adapted online questionnaire from participants following a 2-day webinar. Both descriptive and inferential (bivariate and multivariate) analyses were done. Results: The findings of the study revealed that 55.2% of participants (n = 424) were males and 66.0% (n = 424) were early career researchers. Two hundred and thirty-six participants (55.7%) (n = 424) reported very good acceptability, 67.9% (n = 424) reported very good appropriateness while 54.7% (n = 424) reported good feasibility of webinar for research capacity strengthening. The rating of knowledge obtained from the webinar as 'excellent' increased the odds of acceptability (odd ratio [OR] = 38.30; P < 0.001), appropriateness (OR = 15.65; P < 0.05), and feasibility (OR = 20.85; P < 0.05). Furthermore, the preference for zoom and other online platforms for learning increased odds of acceptability of the webinar (OR = 2.29; confidence interval [CI]: 0.97–57.39; P < 0.05), appropriateness (OR = 2.55; CI: 1.10–5.91; P < 0.05) and feasibility (OR = 2.34; CI: 0.96–5.74; P < 0.05). Conclusion: The study concluded that webinar was acceptable, appropriate and feasible for strengthening research capacity, although poor internet connectivity and cost of data were the major challenges in Nigeria. However, a learner-centred approach in contents' delivery that ensures optimal learning has the potential of enhancing research capacity strengthening via virtual space.
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Willingness to pay for a COVID-19 vaccine for oneself and one's child among individuals attending a tertiary care centre in West Bengal, India p. 296
Tanveer Rehman, Ajay Mallick, Farhad Ahamed, Srikanta Kanungo, Sanghamitra Pati
DOI:10.4103/npmj.npmj_194_22  
Background: The free-of-cost supply could not meet the demand for coronavirus disease-2019 (COVID-19) vaccines in India, so the government approved an injection option with a price. We aimed to determine how much money an individual would be willing to pay for a COVID-19 vaccine for themselves and their children and assess the factors determining it. Methods: We conducted a study among all adults visiting the outpatient department of a government tertiary care hospital in West Bengal, India, in August 2021. Trained nursing officers combined bidding game and open-ended question methods during personal interviews to estimate the willingness-to-pay (WTP) values. Results: The mean (standard deviation) age of 1565 participants was 40.8 (12.2) years with 46.5% (n = 727) males, 70.4% (n = 1102) parents, 50.0% (n = 783) educated upto class 12 and 30.9% (n = 483) belonging to upper-middle socio-economic scale (SES). The median (inter-quartile range [IQR]) WTP amount for the first dose and the subsequent/booster dose among the unvaccinated (50.2%, n = 785) and vaccinated (49.8%, n = 780) participants were ₹0 (0–100) and ₹0 (0–200), respectively. The median (IQR) WTP for inoculating children with any COVID-19 vaccine was ₹50 (0–300) in both groups. Significant differences were found in the WTP prices for adult vaccines in both groups concerning age category (P = 0.02), education (P < 0.01) and SES (P < 0.01). Conclusion: Although more than half of the respondents were unwilling to pay for themselves, WTP for COVID-19 vaccination was higher for their children. Policy-makers should consider income, education and age to cap the private sector vaccination price.
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Non-COVID-19 uptake of personal protective equipment and rules compliance amongst industrial workers in Kano, Nigeria p. 303
Muhammad Garba Rayyan, Usman Muhammad Ibrahim, Usman Sunusi Usman, Karibullah Idris Muhammad
DOI:10.4103/npmj.npmj_214_22  
Background: Every workplace has got hazards in many different forms, ranging from sharps, falling objects, chemicals, infections, noise and a lot of other potentially dangerous situations. The occupational safety and health administration mandates employers to protect their employees from such potentially dangerous workplace hazards. Personal protective equipment (PPE) plays an important role in preventing and ensuring health safety amongst industrial workers. This study aimed to determine the use of PPE and rules compliance amongst Industrial Workers in Kano State. Methods: A cross-sectional study design was used to assess 150 workers selected from the Sharada Industrial Estate, Kano, Nigeria, using a multistage sampling technique. Data were obtained using semi-structured interviewer-administered questionnaires and analysed using SPSS version 22.0. Results: The response rate was 88.2%, and the mean age of respondents was 28.1 ± 7.4. About 72% were male, 74.7% had secondary education and 16.4% reported ever having a child with a congenital anomaly. Up to 25% reported using PPE always, 62% used PPE occasionally and 12% never used PPE. Factors significantly associated with the use of PPE at bivariate level were: Gender, 'provision of statutory regulation by the management', 'provision of PPE on worksite' and 'provision of training to staff' respectively. However, on multivariable regression analysis, only 'provision of statutory regulation by the management' and 'provision of PPE on worksite' were found to be independent (intrinsic) predictors of the use of PPE. Conclusions: Training alone does not necessarily increase the uptake of PPE amongst industrial workers. There is a need to ensure the availability of PPE at the worksite, as well as statutory regulations by industries.
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Evaluation of the effect of nutritive versus non-nutritive pacifiers as adjuncts to local anaesthesia in male neonatal circumcision using the plastibell technique – A prospective randomised controlled study p. 310
Chibuike George Ihediwa, Christopher O Bode, Felix M Alakaloko, Olumide A Elebute, Justina O Seyi-Olajide, Oluwaseun Abiola Ladipo-Ajayi, Adesoji O Ademuyiwa
DOI:10.4103/npmj.npmj_189_22  
Background: Male circumcision is the most common surgical procedure worldwide and is often carried out for religious, cultural, medical and public health reasons. It is commonly performed during the neonatal period. Many studies have now shown that pain is a common intra- and post-operative complication. To ensure proper analgesia during the procedure, many surgeons opt for the use of pacifiers as an adjunct to anaesthesia during neonatal circumcision. The aim of this study is to compare nutritive pacifiers (NPs) versus non-NPs (NNPs) as adjuncts to local anaesthesia in male neonatal circumcision using the Plastibell technique. Methods: A prospective randomised controlled study was carried out between October 2019 and March 2020. A total of 100 neonates were circumcised using the Plastibell technique and randomised into NP (Group A, n = 33), NNP (Group B, n = 33) and controls (Group C, n = 34), respectively. The differences in pain scores using the Neonatal Infant Pain Scale, total crying time and heart rate during circumcision were recorded and assessed. Results: The age of participants ranged from 5 to 28 days and the weight ranged from 2.5 to 5.0 kg. The overall mean age, birth weight and current weight of the participants were 15.5 ± 6.1 days, 3.4 ± 0.4 kg and 3.5 ± 0.6 kg, respectively. The control group had the highest average pain score of 5.5 (4.5–5.8) compared to the intervention groups with median pain score (NP: 3.3 [1.3–4.3] and (NNP: 4.3 [3.1–5.1], respectively). NPs had significantly lower pain scores (P = 0.023) and reduced total crying time (P = 0.019) at all stages of the circumcision compared to those given NNPs and controls. Conclusion: This study showed that NPs were superior to NNPs in providing additional pain control during male neonatal circumcision.
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Socio-demographic factors influencing measures of cognitive function of early adolescent students in abuja, Nigeria p. 317
Vincent Ebuka Nwatah, Patience Abaluomo Ahmed, Lamidi Isah Audu, Selina Nnuaku Okolo
DOI:10.4103/npmj.npmj_157_22  
Background: The brain in the early adolescent period undergoes enhanced changes with the radical reorganisation of the neuronal network leading to improvement in cognitive capacity. A complex interplay exists between environment and genetics that influences the outcome of intellectual capability. We, therefore, aimed to evaluate the relationship between socio-demographic variables and measures of cognitive function (intelligence quotient [IQ] and academic performance) of early adolescents. Methods: The study was a descriptive cross-sectional study of early adolescents aged 10–14 years. Raven's Standard Progressive Matrices was used to assess the IQ and academic performance was assessed by obtaining the average of all the subjects' scores in the last three terms that made up an academic year. A confidence interval of 95% was assumed and a value of P < 0.05 was considered statistically significant. Results: The overall mean (standard deviation) age of the study population was 11.1 years (±1.3) with male-to-female ratio of 1:1. Female sex was associated with better academic performance with P = 0.004. The students with optimal IQ performance were more likely (61.7%) to perform above average than those with sub-optimal IQ performance (28.6%). As the mother's age increased, the likelihood of having optimal IQ performance increased 1.04 times (odds ratio [OR] = 1.04; 95 confidence interval [CI] = 1.01–1.07). Students in private schools were three times more likely to have optimal IQ performance than those from public schools (OR = 2.79; 95 CI = 1.65–4.71). Conclusion: The present study demonstrated that students' IQ performance and the female gender were associated with above-average academic performance. The predictors of optimal IQ performance found in this study were students' age, maternal age and school type.
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Predictors and causes of in-hospital maternal deaths within 120 h of admission at a tertiary hospital in South-Western, Nigeria: A retrospective cohort study p. 325
Joseph Ayodeji Olamijulo, Gbenga Olorunfemi, Halimat Osman
DOI:10.4103/npmj.npmj_180_22  
Background: An efficient, comprehensive emergency obstetrics care (CEMOC) can considerably reduce the burden of maternal mortality (MM) in Nigeria. Information about the risk of maternal death within 120 h of admission can reflect the quality of CEMOC offered. Aim: This study aims to determine the predictors and causes of maternal death within 120 h of admission at the Lagos University Teaching Hospital, LUTH, Lagos South-Western, Nigeria. Methods: We conducted a retrospective cohort study amongst consecutive maternal deaths at a hospital in South-Western Nigeria, from 1 January 2007 to 31 December 2017, using data from patients' medical records. We compared participants that died within 120 h to participants that survived beyond 120 h. Survival life table analysis, Kaplan–Meier plots and multivariable Cox proportional hazard regression were conducted to evaluate the factors affecting survival within 120 h of admission. Stata version 16 statistical software (StatCorp USA) was used for analysis. Results: Of the 430 maternal deaths, 326 had complete records. The mean age of the deceased was 30.7± (5.9) years and median time to death was 24 (5–96) h. Two hundred and sixty-eight (82.2%) women out of 326 died within 120 h of admission. Almost all maternal deaths from uterine rupture (95.2%) and most deaths from obstetric haemorrhage (87.3%), induced miscarriage (88.9%), sepsis (82.9%) and hypertensive disorders of pregnancy (77.9%) occurred within 120 h of admission. Admission to the intensive care unit (P = 0.007), cadre of admitting doctor (P < 0.001), cause of death (P = 0.036) and mode of delivery (P = 0.012) were independent predictors of hazard of death within 120 h. Conclusion: The majority (82.2%) of maternal deaths occurred within 120 h of admission. Investment in the prevention and acute management of uterine rupture, obstetric haemorrhage, sepsis and hypertensive disorders of pregnancy can help to reduce MM within 120 h in our environment.
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Vascular injuries: Aetiology, presentation and management outcomes at a tertiary hospital in Lagos, Nigeria p. 334
Ezekiel Olayiwola Ogunleye, Olugbenga Oluseyi Olusoji, Okezie Obasi Kanu
DOI:10.4103/npmj.npmj_221_22  
Vascular injuries lead to haemorrhagic shock and distal limb ischaemia, especially with an arterial injury. This life-threatening state mandates urgent evaluation and intervention to save life and limbs. The treatment aims to restore blood flow and replace lost blood within the golden hours, stabilising cardiovascular haemodynamics and averting irreversible ischaemic damage. The aim of this study was to analyse the clinical profile of vascular injuries, management and outcomes in our institution. Materials and Methods: This retrospective study covered the period from January 2015 to December 2021. Information of interest were extracted from the medical records of each participant. The results from the data analysis were presented in charts and tables. Results: Seventy-four patients aged 15–78 years (mean 32.30 ± 13.75 years) were included in this study. The male-to-female ratio was 3.6:1. The most common causes were gunshot injury, road traffic accident and iatrogenic injuries. The mean duration from injury to presentation was 9.85 h and mean duration from presentation to restoration of flow was 7.3 h. The most common injured artery was the femoral artery, whereas the most common vein was inferior vena cava. Primary vascular repair was done in majority of the cases. Amputation was performed in 18.9% with loss of viability of the limb. Conclusion: Vascular injury though relatively uncommon remains a challenging and life-threatening disease predominantly in young adult males. Urgent intervention prevents limb loss and mortality. Favourable outcome is accomplished by improving emergency healthcare delivery and well-equipped vascular centres with adequately trained personnel in the nation's hospitals.
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Hoarseness in a nigerian tertiary health facility: Prevalence, aetiology and predisposing factors p. 341
Foluso Mercy Adeyeye, Kufre Robert Iseh, Mohammed Abdullahi
DOI:10.4103/npmj.npmj_184_22  
Objectives: To determine the prevalence, aetiology and predisposing factors in patients presenting with hoarseness to Usmanu Danfodiyo University Teaching Hospital, Sokoto. Methods: The study was a prospective, hospital-based study involving patients with hoarseness ≥7 years. Demographic characteristics and information on voice abuse, smoking, alcohol ingestion and gastroesophageal reflux disease (GERD) were taken. Participants had laryngeal endoscopy using a flexible nasopharyngolaryngoscopy to determine the cause of hoarseness. Results: A prevalence of 2.97% was obtained in the study, and the age range of participants was 7 to 78 years, with a male:female ratio of 1.3:1. The most common cause of hoarseness was laryngeal inflammation 38 (40.0%), followed by benign neoplasm 24 (25.3%) , malignancy 20 (21.1%) and trauma 10 (10.5%). Voice abuse, GERD and smoking were significant predisposing factors for benign neoplasm (χ2 = 8.73; P = 0.0031), inflammation (χ2 = 19.79; P < 0.0001) and malignancy of the larynx (χ2 = 10.66; P = 0.0011), respectively. Conclusion: The study showed that acute and chronic laryngeal infection and neoplasms (benign and malignant) of the larynx were the most common causes of hoarseness. Voice abuse, smoking and GERD were the commonest predisposing factors.
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SPECIAL ARTICLE Top

Striving for excellence in subspecialty medical training in Nigeria: The 6th theophilus oladapo ogunlesi lecture p. 347
Sebastian N N. Nwosu
DOI:10.4103/npmj.npmj_228_22  
The solid foundation laid by Prof Theophilus Oladapo Ogunlesi and other founding fathers of the National Postgraduate Medical College of Nigeria (NPMCN) has consistently achieved its mandate of producing specialist medical practitioners in Nigeria. The ever-changing world requires that we have in Nigeria a critical mass of subspecialists to tackle the various old and emerging ailments that afflict the citizenry. Subspecialist training is popular among Nigerian specialists. While those who are not yet subspecialists crave for the training. Nigerian-born sub-specialists in the diaspora are willing to assist in the training. It is now left to policy makers and captains of the training institutions to seize the chance and move us forward with a view to improving the current embarrassingly low number of subspecialists in Nigeria. The NPMCN is hereby beckoned to take the lead. In doing so, it should combine excellence with relevance.
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