Acceptability, appropriateness and feasibility of webinar in strengthening research capacity in COVID-19 era in Nigeria.

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.

Nigerian Surgical Trainees' Work Schedule: It is Time for a Change!

BACKGROUND: Unregulated work schedules have deleterious effects on trainees' productivity and patients' safety. For these reasons, duty hours have been capped in many developed countries. Such regulations, however, appear to be lacking in many parts of Africa, and the effects of unregulated work hours in this part of the world have only been scantily documented. This study evaluated the work schedule of Nigerian surgical trainees, and its impact on their wellbeing, as well as assessed the perception of trainees towards capped duty hours. METHODS: A cross-sectional survey of 650 Nigerian Resident Doctors in surgical specialties was conducted in November 2020. Enquiries were made about their work schedules using a purpose-designed questionnaire, developed using Google Forms®. The data were analysed using the IBM SPSS version 23. RESULTS: The mean weekly work hours of surgical residents was 122.72 ± 34.17 h. Majority (228, 40.4%) of the residents had cumulative call hours of ≥ 72 h per week. One-half (283, 50.1%) of them worked continuously for up to 48-72 h during calls, with mean daily sleep hours of 3.53 ± 1.42 h during calls. The majority (558, 98.8%) of respondents had post-call clinical responsibilities. Seventy-five percent of the respondents reported hazards from prolonged work hours, and an overwhelming majority (530, 93.8%) desire official limits on work hours. CONCLUSION: Prolonged, unregulated work schedules appear to be the norm among Nigerian surgical trainees. This trend calls for urgent measures, to avoid potentially catastrophic consequences on both physicians and patients.

Impact of the COVID-19 Pandemic on Surgical Residency Training: Perspective from a Low-Middle Income Country.

BACKGROUND: The COVID-19 pandemic has drastically impacted postgraduate training programmes worldwide. This study aims to evaluate the Nigerian situation with respect to surgical training, with a view to identifying gaps and proffering solutions. METHODS: A cross-sectional survey of surgical residents in Nigeria was conducted between 27 July 2020 and 14 August 2020. A structured questionnaire designed using the free software Google Forms® was utilised for the study. The questionnaire was electronically distributed randomly to 250 surgical residents via emails and social media platforms including WhatsApp and Telegram. The data obtained was analysed by Google Forms®. Ethical approval for the study was obtained from the ethics and research unit of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State, Nigeria. RESULTS: At the end of the study period, 207 surgical residents completed and submitted the questionnaire, giving a response rate of 82.8%. The majority of respondents reported a reduction (164, 79.2%) or cancellation (11, 5.3%) of postgraduate programmes in their institutions. Of those who had academic programmes, meetings were done using virtual technology in all instances. The majority of respondents reported seeing fewer patients in the outpatient clinics (173, 83.6%), as well as a reduction in the number of emergency and elective operations (58.5% and 90.8%, respectively). About a third of the respondents (70, 33.8%) were contemplating emigrating from the country. CONCLUSION: The COVID-19 pandemic has significantly affected the clinical, research and teaching components of surgical training in Nigeria. It has, however, led to increased adoption of digital technology which should be further explored in the face of current realities.

Maternal mortality in the last triennium of the Millennium Development Goal Era at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.

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.

Adherence to Practice Guidelines in the Implementation of Emergency Obstetric and Newborn Care in Referral Hospitals in Osun State, Nigeria.

Introduction: While practice guidelines support clinical decision-making for optimal patient outcomes, there is often nonadherence to practice guidelines in implementing evidence-based interventions. Objectives: This article aimed to assess adherence to practice guidelines in emergency obstetric and newborn care (EmONC) and the outcome of pregnancy in cases of obstetric complications in referral hospitals. Method: The study employed a descriptive design. A purposive sampling technique was used to select the three tertiary hospitals and six out of nine state hospitals in Osun State. A data extraction form developed based on a fidelity framework was used to collect data on Adherence from 264 cases of obstetric complications. Descriptive statistics, such as frequency and percentage, and inferential statistics, such as chi-square, were done with the significance level set as p < .05. Results: Findings showed low adherence to practice guidelines in 70.8% of hemorrhage care, 52.0% of fetal distress care, 60.0% of prolonged obstructed labor care, and 44.4% of preeclampsia/eclampsia care. The study's findings also showed that 64.3% of cases of prolonged/obstructed labor, 54.9% of cases of fetal distress, and 46.7% of all cases of obstetric complications were referred out at the state hospitals. Neonatal mortality in state and tertiary hospitals was 3.7% and 21.7%, respectively, which was significantly different (p < .001). Conclusion: There was low adherence to practice guidelines for the implementation of EmONC in state and tertiary hospitals, and a significant number of cases of obstetric complications were referred out in the state hospitals. The low adherence to practice guidelines and numerous referrals truncate the successful implementation of EmONC and hinder women and newborns from receiving optimal care for obstetric complications. There is a need to develop strategies that promote adherence to practice guidelines in implementing EmONC.

Trends and Outcomes of Twin Births in Southwest Nigeria: A 14-Year Retrospective Cohort Study.

Background and objectives: The study aimed to analyze the prevalence, trends, and outcomes of twin pregnancies in Ile-Ife, Nigeria, over two distinct periods. Materials and methods: This research, based on a 14-year retrospective cohort study, scrutinized twin births occurring in two-time frames: recent years (2012-2018; Period II) and the recent past (2005-2011; Period I) at a University Teaching Hospital in Ile-Ife, Nigeria. The inclusion criteria were limited to twin births, excluding singleton and higher-order gestations. Outcomes were evaluated based on several parameters, including mode of delivery, birth weights, fetal gender combinations, APGAR scores, perinatal mortality, and maternal complications. Data analysis was conducted using the 26th version of Statistical Package for the Social Science, with a significance threshold of p < 0.05. Results: The study documented a stable prevalence of twin gestations, registering at 20.7 per 1,000 births without a significant discrepancy between the two time periods (21.7‰ versus 19.7‰; p = 0.699). Individuals from the Yoruba tribe predominantly featured in both cohorts, showing no considerable variation between the two time periods [83 (95.4) vs. 120 (99.2); p-value = 0.116]). The data exhibited recurrent instances of caesarean delivery (65.6% vs. 50.2%, p = 0.119), vertex-vertex presentation (38.0% vs. 44.7%, p = 0.352), and differing sex combinations (33.3% vs. 38.0%, p = 0.722) across both time frames. Twin II neonates born through Caesarean section were more frequently admitted to neonatal intensive care units than Twin I (5.1% versus 4.6%; p = 0.001). The recent years witnessed a surge in preterm labor complications, notably higher than the earlier period (17.1% versus 7.8%; p = 0.008). Conclusion: The prevalence of twin births in Ile-Ife, Nigeria, demonstrates a fluctuating decline. To comprehensively understand the dynamics of twin births in the region, there is a pressing need for expansive, community-centric research in southwest Nigeria.

Mpox in pregnancy: Management, risks and challenges in Africa and lessons from the COVID-19 pandemic.

Data on mpox in pregnancy are currently limited. Historically, only 65 cases in pregnancy have been reported globally since mpox was discovered in 1958. This includes 59 cases in the current outbreak. Vertical transmission was confirmed in one patient. Pregnant women are at high risk of severe disease owing to immunological and hormonal changes that increase susceptibility to infections in pregnancy. African women appear to be at higher risk of mpox infection and adverse outcomes in pregnancy for epidemiological and immunologic reasons, in addition to the background high rates of adverse feto-maternal outcomes in the region. This risk is potentially heightened during the COVID-19 pandemic due to the possibility of mpox virus exportation/importation as a result of the lifting of movement restrictions and trans-border travels between countries affected by the current outbreak. Furthermore, coinfection with mpox and COVID-19 in pregnancy is possible, and the clinical features of both conditions may overlap. Challenges of diagnosis and management of mpox in pregnancy in Africa include patients concealing their travel history from healthcare providers and absconding from/evading isolation after diagnosis, shortage of personal protective equipment and polymerase chain reaction testing facilities for diagnosis, vaccine hesitancy/resistance, and poor disease notification systems. There is a need for local, regional and global support to strengthen the capacity of African countries to address these challenges and potentially reduce the disease burden among pregnant women in the continent.

COVID-19: the implications and consequences of prolonged lockdown and COVID-19 vaccine cost in a low-middle income country.

Lockdowns and just recently, the COVID-19 vaccines, are amongst the disease containment measures instituted globally to check the spread of COVID-19. Prolonged lockdowns are however, not sustainable in low resource economies like Nigeria, where up to 70% of her population live on less than a dollar a day, with the majority, either unemployed, or working in the private/informal sector and depending on daily earnings for survival. If the lockdown remains sustained, it would not be long before the largely poor citizens starve to death. Also, spending over US $3.9 billion on COVID-19 vaccines for more than 200 million Nigerians, as intended by the Nigerian government, is not plausible, given that neglected tropical diseases (NTDs) like Lassa fever, and other more common causes of morbidity and mortality, continue to kill more Nigerians than COVID-19. Public enlightenment of the populace on the need to strictly adhere to non-pharmacologic preventive measures, including social distancing, use of face masks, good personal hygiene, covering of the mouth and nose when coughing and sneezing, frequent hand washing and sanitizing with alcohol-based hand-sanitizers and disinfection of surfaces, is what is sustainable, feasible and compatible with the economic reality in our setting. As Sir Robert Hutchison, the highly revered doyen of medicine, wrote in his petition over 85 years ago, "And from making the cure of the disease more grievous than the endurance of the same, Good Lord, deliver us", we must be careful not to make the cure of COVID-19 worse than COVID-19 itself.

Correlation of Foetal Liver Length with Gestational Age and Foetal Weight in Pregnant Nigerian Women.

Background: This study aims to determine the relationship(s) of fetal liver length (FLL) to the gestational age, biometric parameters (BPD, FL, AC, HC), and fetal weight in third trimester pregnancies. Methodology: This was a hospital-based cross-sectional study of 400 fetuses in normal third trimester pregnancies recruited from the Obstetrics and Gynaecology department of OAUTHC, Ile-Ife, Nigeria. The participants were between 20-45 years of age and their gestational ages ranged from 27-40weeks. The FLL, liver thickness and transverse diameter were measured on B-mode ultrasound. Fetal liver volume (FLV) was calculated using the ellipsoid formula. The expected gestational age (EGA) was determined from the date of the last menstrual period (LMP), early first-trimester crown-rump length (CRL), or early second-trimester biparietal diameter (BPD) ultrasound. The estimated gestational age (EGA) and EFW were calculated using computer-assisted analysis of ultrasound fetal biometrics. Results: The mean height, weight, and body mass index (BMI) of the participants were 1.62±0.08m, 72.07±13.26kg and 27±4.70kg/m2 respectively. FLL had a linear relationship and a positive correlation with EGA and EFW. There was also a positive correlation between FLL and fetal biometrics, maternal weight, and BMI. Percentile distribution of FLL and FLV for the GA 27-40weeks was developed. Conclusion: FLL could be used to predict GA in normal pregnancies especially when LMP is uncertain.

Eight-hour versus 24-h urethral catheter removal following elective caesarean section for reducing significant bacteriuria: A randomized controlled trial.

BACKGROUND: There is no consensus on the preferred time to remove urethral catheter post caesarean section. AIM: To compare rate of significant bacteriuria and urinary retention following 8-h (study) and 24-h urethral catheter removal (control) post elective caesarean section. METHODS: A randomized controlled trial of eligible participants that underwent elective caesarean section under spinal anaesthesia between March 2019 and November 2019 was conducted. Participants (150 in each arm) were randomly assigned (1:1 ratio) to either 8-h or 24-h group. Primary outcome measures included rates of significant bacteriuria 48-h post-operatively and acute urine retention 6-h post urethral catheter removal. Analysis was by Intention-to-treat. (www.pactr.org:PACTR202105874744483). RESULTS: There were 150 participants randomized into each arm and data collection was complete. Significant bacteriuria was less in 8-h group (3% versus 6.0%; risk ratio (RR): 0.85 CI: 0.60 to 5.66; p = 0.274), though not significant. Acute urinary retention requiring repeat catheterisation was significantly higher in 8-h group (11(7.3%) versus 0(0.0%); RR: 0.07; CI: 0.87 to 0.97; p = 0.001). Mean time until first voiding was slightly higher in 8-h group (211.4 ± 14.3 min versus 190.0 ± 18.3 min; mean difference (MD): 21.36; CI: -24.36 to 67.08; p = 0.203); but patient in this group had a lower mean time until ambulation (770.0 ± 26.1 min versus 809 ± 26.2 min; MD: -38.8; CI: -111.6 to 34.0; p = 0.300). The 8-h group were significantly more satisfied (82/150 (54.7%) versus 54/150 (36.0%); p = 0.001). CONCLUSIONS: An 8-h group was associated with significant clinical satisfaction and acute urine retention compared to 24-h removal. The timing of urethral catheter removal did not affect rate of significant bacteriuria and other outcomes.

Impact of COVID-19 on the cost of surgical and obstetric care: experience from a Nigerian teaching hospital and a review of the Nigerian situation.

The public health impact of the COVID-19 pandemic cannot be overstated. Its impact on the cost of surgical and obstetric care is significant. More so, in a country like Nigeria, where even before the pandemic, out-of-pocket spending (OOPS) has been the major payment method for healthcare. The increased cost of surgical and obstetric care occasioned by the pandemic has principally been due to the additional burden of ensuring the use of adequate/appropriate personal protective equipment (PPE) during patient care as a disease containment measure. These PPE are not readily available in public hospitals across Nigeria. Patients are therefore compelled to bear the financial burden of procuring scarce PPE for use by health care personnel, further increasing the already high cost of healthcare. In this study, we sought to appraise the impact of the COVID-19 pandemic on the cost of surgical and obstetric care in Nigeria, drawing from the experience from one of the major Nigerian teaching hospitals- the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State. The cost of surgical and obstetric care was reviewed and compared pre- and during the COVID-19 pandemic, deriving relevant examples from some commonly performed surgical operations in our centre (OAUTHC). We reviewed patients' hospital bills and receipts of consumables procured for surgery. Our findings revealed that the cost of surgical and obstetric care during the COVID-19 pandemic had significantly increased. We identified gaps and made relevant recommendations on measures to reduce the additional costs of surgical and obstetric care during and beyond pandemic.