Correlates of post-traumatic stress disorder among adult residents of conflict-affected communities in Cross River State, Nigeria: a cross-sectional study.

BACKGROUND: Conflict-affected communities in Nigeria experience a range of problems. These experiences have been associated with different types of mental disorders, most notably, post-traumatic stress disorder (PTSD). AIM: This study sought to assess PTSD and its associated factors among adults in conflict-affected communities in Odukpani Local Government Area (LGA), Cross River State, Nigeria. METHODS: A cross-sectional study was conducted using non-probability and probability sampling techniques. The sample size for this study was 486 conflict-affected adults. The symptoms of PTSD were assessed using the Harvard Trauma Questionnaire and a semistructured questionnaire was employed to collect data on sociodemographic and trauma-related characteristics. Data were analysed using descriptive statistics, χ2 and multivariable logistic regression. RESULTS: The prevalence of PTSD in conflict-affected communities in Odukpani LGA, Cross River State, Nigeria was 73.9%. The multivariate analysis revealed that higher educational attainment (AOR 5.66; p<0.001; 95% CI 2.37 to 13.54), family size >4 (AOR 1.72; p=0.03; 95% CI 1.06 to 2.77), discrimination because of present status (AOR 1.96; p=0.03; 95% CI 1.26 to 3.06) and family history of mental illnesses (AOR 2.08; p=0.002; 95% CI 1.31 to 3.31) showed statistically significant relationships with PTSD in the study population. CONCLUSION: A multisectoral approach for creating and routinely arranging mental health interventions and aid programmes aimed at improving social outcomes such as employment, living conditions and social networks for conflict-affected communities is recommended.

Implementing health worker training on sepsis in South Eastern Nigeria using innovative digital strategies: an interventional study.

Background: Sepsis is a leading cause of morbidity and mortality especially in low- and middle-income countries such as Nigeria. Training of health workers using digital platforms may improve knowledge and lead to better patient outcomes. Objectives: To assess the effectiveness of a digital health educational module on sepsis in improving the knowledge of medical doctors in Cross River State Nigeria on the diagnosis and management of patients presenting with sepsis. Design: Quasi-experimental analytical study. Methods: We developed and deployed a sepsis module through an innovative application (Sepsis tutorial app) to doctors in Calabar, Nigeria. We assessed quantitative pre- and post-intervention knowledge scores for those completing the tutorial on sepsis between both assessments. A user satisfaction survey evaluated the content of the tutorial and the usability of the app. Results: One hundred and two doctors completed the course. There were more males than females (58.8% versus 41.2%). Over half (52%) were junior doctors, a minority were general practitioners and house officers (3% and 5%, respectively), and 72.6% had practiced for periods ranging from 1 to 15 years post-qualification. Gender and age appeared to have no significant association with pre- and post-test scores. The oldest age group (61-70) had the lowest mean pre- and post-test scores, while general practitioners had higher mean pre- and post-test scores than other cadres. The majority (95%) of participants recorded higher post-test than pre-test scores with a significant overall increase in mean scores (25.5 ± 14.7%, p < 0.0001). Participants were satisfied with the content and multimodal delivery of the material and found the app usable. Conclusion: Digital training using context-responsive platforms is feasible and may be used to close the critical knowledge gap required to respond effectively to medical emergencies such as sepsis in low- to middle-income settings.

Training health workers on sepsis using digital strategies Sepsis occurs when the body injures itself as it attempts to fight an infection. It is now recognized as a leading cause of death especially in low- and middle-income countries such as Nigeria. Training of health workers using digital platforms may improve knowledge and lead to better patient outcomes. We assessed the effectiveness of a digital health educational course on sepsis in improving the knowledge of medical doctors in Cross River State, Nigeria on the diagnosis and management of patients presenting with sepsis. One hundred and two doctors completed the course. Most participants recorded higher post-test than pre-test scores, were generally satisfied with the content and delivery of the material, and found the app usable. We conclude that digital training using digital platforms may be useful in bridging the critical knowledge gap required to respond effectively to sepsis in low- to middle-income settings.

Proximate determinants and decomposition of changes in fertility levels across Nigeria regions: Evidence from Nigeria Demographic Health Survey, 2003-2018.

There is disparity in fertility level across the six geopolitical zones in Nigeria. Deeper uunderstanding about the drivers of fertility trends are necessary to prioritize zonal specific strategies for fertility reduction in Nigeria. Thus, this study examined the proximate determinants (PDs) of fertility and decomposed the change in its level across the six geo-political zones in Nigeria. Data from Nigeria Demographic and Health Surveys of 2003 and 2018 were analyzed. Fertility data were based on the report of full birth history from women of reproductive age. The Revised Bongaarts framework was used to estimate PDs and fertility levels. The contribution of each PDs to the observed changes in fertility levels was quantified using Das Gupta's five- factor decomposition method. The Total fertility rate (TFR) in 2003 and 2008 across the zones are South-South (5.04 vs 4.36), South-West (4.88 vs 4.26), North West (7.25 vs 6.85), North East (6.87 vs 6.54), North Central (5.72 vs 5.48), South East (5.06 vs 4.86), Nigeria (6.00 vs 5.59). Across the zones, there was a change in the fertility inhibiting effect of Contraception (Cc) between 2003 and 2018. The fertility inhibiting effect of Postpartum Infecundability (Ci) and Abortion was the highest and smallest respectively across the zones. Delayed sexual exposure (Cm) and contraceptive use (Cc) contributed the most to the change across the regions. The percentage contribution of Cm in South-South, South West, and South East was 87.04%, 52.89%, and 172.85% respectively. Furthermore, most of the fertility change observed in North Central was attributable to Cc. Abortion index was not an important inhibiting factor of fertility in Nigeria. Delayed sexual exposure and contraceptive use accounted for the largest change observed in fertility levels across the six geo-political zones in Nigeria between 2003 and 2018. Strategies that promote delayed sexual exposure, contraceptive use and breast feeding practices will enhance fertility transition in Nigeria.

Use of Short Message Service (SMS) in a Chronic Kidney Disease Screening Programme: A Feasibility Study.

Background: Community screening for chronic kidney disease has often been based on single measurements of markers of kidney damage worldwide. The evaluation of kidney dysfunction and related risk factors may be facilitated by the deployment of telehealth services such as short message service. Methodology: Cross-sectional study for screening participants for CKD and risk factors during a world kidney event at two communities in Calabar, Cross River State. Short message service (SMS) was used to remind and invite participants to attend a kidney clinic to recheck their kidney functions and subsequently adjust initial point prevalence estimates based on this outcome. Chronic Kidney disease was defined as eGFR less than 60ml/min/1.73m2 and/or proteinuria. Results: A total of 230 consenting participants were screened with an overall mean age of 36.43 ±11.69 years. 145 (62.7%) were either obese or overweight, while 25 (10.9%), 10 (4.3%) and 1 (0.4%) had a history of hypertension, diabetes, and CKD, respectively. Various degrees of proteinuria were found in 50 (21.74%) participants. Eleven participants had low eGFR <60mL/min. The point prevalence of CKD at the first screening was 24.3% (95%CI 18.9 - 30.4). Of those with either proteinuria or low eGFR, only 12(24%) and 5(45.4%) respectively represented themselves for recheck following the text messages. The adjusted point prevalence was 20.1%. Conclusion: There is a low level of response to recall for rescreening for urinary and blood markers of kidney disease using mobile phone short message service in our population. The determinants and drivers of response will need to be studied.

Correlates of somatic symptom disorder among internally displaced persons in Ogoja displacement settlements, Nigeria: a cross-sectional study.

Background: Experiences of displacement have been associated with the prevalence of mental health disorders owing to certain factors. Objectives: This study aimed to identify the correlates of Somatic Symptom Disorder (SSD) among internally displaced adults in Ogoja displacement settlements, Nigeria. Methods: This was a cross-sectional study of 335 respondents. SSD was assessed using the SOM-SCL section of the Common Mental Disorder Questionnaire while a semi-structured questionnaire was used to collect data on sociodemographic and displacement-related factors. Data were analysed using descriptive statistics, Chi-square, and multivariable logistic regression. Result: The prevalence of somatoform disorder was 59.1%. Factors found to be significant in each bivariate Chi-square analysis were modelled for the mental disorder. The multivariate analysis revealed that being married (AOR=2.80; p=0.020) prolonged displacement (AOR=3.29; p=0.003), discrimination (AOR=2.25; p=0.010), disease outbreak (AOR=1.92; p=0.030), loss of loved ones (AOR=1.34; p=0.028), overcrowded households (AOR=2.30; p=0.008), and fear of reprisals (AOR=2.05; p=0.026) were significantly associated with somatoform disorder. Conclusion: The findings suggest that the high prevalence of the studied outcome is related to several stressors and events among Internally displaced persons. Evidence-based mental health support efforts by different bodies in creating and routinely arranging mental health clinical interventions for this population is recommended.

mHealth guideline training for non-communicable diseases in primary care facilities in Nigeria: a mixed methods pilot study.

OBJECTIVE: To pilot the use of a scalable innovative mobile health (mHealth) non-communicable diseases (NCDs) training application for nurses at the primary care level. DESIGN: Mixed methods pilot of mHealth training on NCD care for nurses at primary healthcare (PHC) facilities. We provide a descriptive analysis of mHealth training test scores, with trend analysis of blood pressure (BP) control using paired t-test for quantitative data and thematic analysis for qualitative data. SETTING: PHC facilities in rural and urban communities in Cross River State, south eastern Nigeria. NCDs were not part of routine training previously. As in most low-and-middle-income settings, funding for scale-up using conventional classroom in-service training for NCDs is not available in Nigeria, and onsite supervision poses challenges. PARTICIPANTS: Twenty-four health workers in 19 PHC facilities. INTERVENTION: A self-paced mHealth training module on an NCD desk guide was adapted to be applicable within the Nigerian context in collaboration with the Federal Ministry of Health. The training which focused on hypertension, diabetes and sickle cell disease was delivered via Android tablet devices, supplemented by quarterly onsite supervision and group support via WhatsApp. The training was evaluated with pre/post-course tests, structured observations and focus group discussions. This was an implementation pilot assessing the feasibility and potential effectiveness of mHealth training on NCD in primary care delivery. RESULTS: Nurses who received mHealth training recorded a statistically significant difference (p<0.001) in average pretest and post-test training scores of 65.2 (±12.2) and 86.5 (±7.9), respectively. Recordings on treatment cards indicated appropriate diagnosis and follow-up of patients with hypertension with significant improvements in systolic BP (t=5.09, p<0.001) and diastolic BP (t=5.07, p<0.001). The mHealth nurse training and WhatsApp support groups were perceived as valuable experiences and obviated the need for face-to-face training. Increased workload, non-availability of medications, facility-level conflicts and poor task shifting were identified challenges. CONCLUSIONS: This initiative provides evidence of the feasibility of implementing an NCD care package supported by mHealth training for health workers in PHCs and the strong possibility of successful scale-up nationally.

Training health workers at scale in Nigeria to fight COVID-19 using the InStrat COVID-19 tutorial app: an e-health interventional study.

BACKGROUND: Health worker training is an essential component of epidemic control; rapid delivery of such training is possible in low-middle income countries with digital platforms. METHODS: Based on prior experience with the Ebola outbreak, we developed and deployed a bespoke InStrat COVID-19 tutorial app, to deliver accurate and regularly updated information about COVID-19 to frontline health workers and epidemic response officers across 25 states of Nigeria. The potential effectiveness of this app in training frontline health workers was assessed through online pre- and post-tests and a survey. RESULTS: A total of 1051 health workers from 25 states across Nigeria undertook the e-learning on the InStrat COVID-19 training app. Of these, 627 (57%) completed both the pre- and post-tests in addition to completing the training modules. Overall, there were statistically significant differences between pre- and post-tests knowledge scores (54 increasing to 74). There were also differences in the subcategories of sex, region and cadre. There were higher post-test scores in males compared with females, younger versus older and southern compared with northern Nigeria. A total of 65 (50%) of the participants reported that the app increased their understanding of COVID-19, while 69 (53%) stated that they had applied the knowledge and skills learnt at work. Overall, the functionality and usability of the app were satisfactory. CONCLUSION: Capacity building for epidemic control using e-health applications is potentially effective, can be delivered at minimal cost and service disruption and can serve as a tool for capacity building in similar contexts.