A qualitative inquiry of rural-urban inequalities in the distribution and retention of healthcare workers in southern Nigeria.

INTRODUCTION: Globally, the population in rural communities are disproportionately cared for by only 25% and 38% of the total physicians and nursing staff, respectively; hence, the poor health outcomes in these communities. This condition is worse in Nigeria by the critical shortage of skilled healthcare workforce. This study aimed to explore factors responsible for the uneven distribution of healthcare workers (physicians and nurses) to rural areas of Ebonyi State, Nigeria. METHODS: Qualitative data were obtained using semi-structured in-depth interviews and focus group discussions from purposively selected physicians, nurses, and policymakers in the state. Data was analysed for themes related to factors influencing the mal-distribution of healthcare workers (physicians and nurses) to rural areas. The qualitative analysis involved the use of both inductive and deductive reasoning in an iterative manner. RESULTS: This study showed that there were diverse reasons for the uneven distribution of skilled healthcare workers in Ebonyi State. This was broadly classified into three themes; socio-cultural, healthcare system, and personal healthcare workers' intrinsic factors. The socio-cultural factors include symbolic capital and stigma while healthcare system and governance issues include poor human resources for health policy and planning, work resources and environment, decentralization, salary differences, skewed distribution of tertiary health facilities to urban area and political interference. The intrinsic healthcare workers' factors include career progression and prospect, negative effect on family life, personal characteristics and background, isolation, personal perceptions and beliefs. CONCLUSIONS: There may be a need to implement both non-financial and financial actions to encourage more urban to rural migration of healthcare workers (physicians and nurses) and to provide incentives for the retention of rural-based health workers.

Evaluation of current knowledge, awareness and practice of spirometry among hospital -based Nigerian doctors.

BACKGROUND: Spirometry is a cost-effective diagnostic tool for evaluation of lung function and for case-finding in a resource-limited setting. The acceptance of this test depends on the awareness of its indications and the ability to interpret the results. No studies have assessed the knowledge of spirometry among Nigerian doctors. The aim of this study was to evaluate the current knowledge, awareness and practice of spirometry among hospital-based Nigerian doctors. METHODS: We carried out a cross-sectional survey among 321 doctors working in Nigerian hospitals between March 2008 and June 2008. Information on knowledge, awareness, practice of and barriers to spirometry were obtained using a pre-tested, self-administered structured questionnaire and the data were then analysed. RESULTS: Of the 321 doctors that participated, 108 (33.6%) reported that they have good knowledge of spirometry. One hundred and ninety-five (60.7%) were aware of the importance of spirometry in aiding the diagnosis of respiratory diseases; 213(66.4%) were aware of the importance of spirometry in determining the severity of diseases. Medical school was the most common source of knowledge on spirometry (64.5%). Eighty-one (25.2%) doctors reported having a spirometer in their hospitals. Doctors having access to a spirometer used it more frequently for aiding the diagnosis of COPD (40.7% vs.27.5%) and for monitoring of asthma (18.5% vs.11.3%) than those without access to a spirometer. The doctors working in University Teaching Hospitals and Federal Medical Centres (FMC) (22.4% vs. 4.5%) and those having access to a spirometer (40.7 vs.11.3%) were very confident of interpreting spirometry results compared to those working in District and General Hospitals and without access to a spirometer. Irrespective of access to a spirometer or the type of hospital they were employed in, doctors reported that unavailability of a spirometer was the greatest barrier to its use (62.5%) followed by lack of awareness about its usefulness (17.2%). CONCLUSION: The knowledge and practice of spirometry were poor among hospital-based Nigerian doctors because of unavailability of spirometers in most hospitals. These findings have implications for further evaluation, planning and management of patient care in respiratory disease. Spirometers should be made available in all hospitals, and the knowledge of spirometry should be improved among doctors.

Knowledge of and practices related to smoking cessation among physicians in Nigeria.

OBJECTIVE: To evaluate the knowledge and practices of smoking cessation among physicians in Nigeria. METHODS: We conducted a cross-sectional survey in Lagos and three geopolitical zones of Nigeria. A self-administered structured questionnaire was used to obtain information on tobacco use and its health effects, as well as on the knowledge and practices of smoking cessation, from 436 physicians. RESULTS: Of the 436 physicians, 292 (67.0%) were aware of smoking cessation, but only 132 (30.3%) showed good knowledge on this topic. The prevalence of smoking among the physicians was 17.7%. In addition, 308 physicians (70.6%) reported that tobacco education in the medical school curriculum was inadequate. Of the 436 physicians, 372 (86.2%) asked their patients whether they smoked, and 172 (39.4%) asked their patients the reasons for using tobacco. As a means of smoking cessation intervention, 268 (61.5%) used brief advice/counseling (2-5 min), 12 (3.7%) prescribed antidepressants, 16 (2.8%) prescribed nicotine replacement therapy (NRT), and 76 (17.4%) arranged follow-up visits. When the physicians were questioned regarding the obstacles to smoking cessation interventions, 289 (66.3%) cited poor knowledge of the issue, 55 (12.6%) cited a lack of time, and 20 (4.6%) cited unavailability of NRT. CONCLUSIONS: The results of this study highlight the lack of knowledge among physicians in Nigeria in terms of smoking cessation, as well as their failure to apply appropriate practices. The results of this study can further the evaluation and formulation of guidelines on smoking cessation and smoking education programs for physicians. Our findings also underscore the need to offer smoking cessation programs in all treatment facilities.

Knowledge of and practices related to smoking cessation among physicians in Nigeria / Conhecimento e práticas para a cessação do tabagismo entre médicos nigerianos

OBJECTIVE: To evaluate the knowledge and practices of smoking cessation among physicians in Nigeria. METHODS: We conducted a cross-sectional survey in Lagos and three geopolitical zones of Nigeria. A self-administered structured questionnaire was used to obtain information on tobacco use and its health effects, as well as on the knowledge and practices of smoking cessation, from 436 physicians. RESULTS: Of the 436 physicians, 292 (67.0 percent) were aware of smoking cessation, but only 132 (30.3 percent) showed good knowledge on this topic. The prevalence of smoking among the physicians was 17.7 percent. In addition, 308 physicians (70.6 percent) reported that tobacco education in the medical school curriculum was inadequate. Of the 436 physicians, 372 (86.2 percent) asked their patients whether they smoked, and 172 (39.4 percent) asked their patients the reasons for using tobacco. As a means of smoking cessation intervention, 268 (61.5 percent) used brief advice/counseling (2-5 min), 12 (3.7 percent) prescribed antidepressants, 16 (2.8 percent) prescribed nicotine replacement therapy (NRT), and 76 (17.4 percent) arranged follow-up visits. When the physicians were questioned regarding the obstacles to smoking cessation interventions, 289 (66.3 percent) cited poor knowledge of the issue, 55 (12.6 percent) cited a lack of time, and 20 (4.6 percent) cited unavailability of NRT. CONCLUSIONS: The results of this study highlight the lack of knowledge among physicians in Nigeria in terms of smoking cessation, as well as their failure to apply appropriate practices. The results of this study can further the evaluation and formulation of guidelines on smoking cessation and smoking education programs for physicians. Our findings also underscore the need to offer smoking cessation programs in all treatment facilities.

OBJETIVO: Avaliar o conhecimento e as práticas para a cessação do tabagismo entre médicos na Nigéria. MÉTODOS: Um inquérito transversal foi realizado na cidade de Lagos e em três zonas geopolíticas da Nigéria. Um questionário estruturado de autopreenchimento foi respondido por 436 médicos para a obtenção de informações a respeito do uso de tabaco e de seus efeitos na saúde, seu conhecimento e as práticas para cessação do tabagismo. RESULTADOS: Dos 436 médicos, 292 (67,0 por cento) estavam informados a respeito da cessação do tabagismo, mas somente 132 (30,3 por cento) demonstraram bons conhecimentos sobre esse assunto. A prevalência de tabagismo entre os médicos foi de 17,7 por cento. Além disso, 308 médicos (70,6 por cento) relataram que a educação sobre tabagismo nos currículos de medicina era inadequada. Dos 436 médicos, 372 (86,2 por cento) questionavam seus pacientes quanto ao tabagismo, e 172 (39,4 por cento) os questionavam quanto aos motivos para o fumo. Como forma de intervenção para a cessação do tabagismo, 268 (61,5 por cento) utilizavam breve aconselhamento (2-5 min), 12 (3,7 por cento) prescreviam antidepressivos, 16 (2,8 por cento) prescreviam terapia de reposição nicotínica (TRN), e 76 (17,4 por cento) agendavam consultas de acompanhamento. Quando os médicos eram questionados quanto aos obstáculos para as intervenções para a cessação do tabagismo, 289 (66,3 por cento) citaram pouco conhecimento do assunto, 55 (12,6 por cento) citaram a falta de tempo, e 20 (4,6 por cento) a indisponibilidade de TRN. CONCLUSÕES: Os resultados deste estudo destacam a falta de conhecimento dos médicos na Nigéria quanto à cessação do tabagismo, assim como a sua falha em aplicar práticas adequadas. Os resultados deste estudo podem auxiliar na avaliação e na formulação de diretrizes sobre cessação do tabagismo e de programas de educação em tabagismo para médicos. Nossos achados também destacam a necessidade da oferta de programas para cessação ...