COVID-19: Challenges and coping strategies in radiology departments in Nigeria.

Context: COVID-19 came suddenly, bringing to the fore the challenges inherent in the health system. In a developing country, such as Nigeria, which already had myriad problems with funds and equipment in the health sector. Aims: This study aims to examine the challenges encountered by the staff in Radiology facilities and how they combated the challenges. Settings and Design: A descriptive cross-sectional study of radiology facilities in Nigeria. Subjects and Methods: Radiologists from nine government and four private facilities who attended to COVID-19 patients were asked to fill questionnaires on challenges faced and their coping strategies. Responses were sent through E-mail. Statistical Analysis Used: Data from the responses were analyzed using Microsoft excel for Mac 2011 and presented as figures and tables. Results: Majority of the government 7 (77.8%) and private facilities 4 (100%) had no equipment dedicated only to COVID-19 patients. Seven (77.8%) government facilities complained of inadequate staff, poor availability of personal protective equipment (PPEs) 8 (88.9%), and lack of technology for remote viewing 7 (77.8%). Fear of cross-infection was a challenge in one of the facilities 1 (11.1%). Coping strategies adopted include ensuring less traffic in the department by discouraging walk-in patients and canceling non-emergent cases, booking suspected/confirmed cases for lighter times, using old film for face shields and cloth for facemasks, staff education on COVID-19 and preventive measures, and sending reports to physicians through E-mail. Conclusions: There were a lot of challenges during the COVID-19 crisis, with government hospitals experiencing more challenges than private facilities. The challenges included among others inadequate staff strength and lack of technology for remote viewing. Some were overcome using education and by production of facemasks/shields production using recycled materials.

RésuméLe contexte: COVID-19 came suddenly, bringing to the fore the challenges inherent in the health system. Dans un pays en développement, comme Le Nigeria, qui avait déjà une myriade de problèmes de fonds et d'équipements dans le secteur de la santé. Objectifs : Cette étude vise à examiner les défis rencontrés par le personnel des établissements de radiologie et comment ils ont relevé les défis. Paramètres et conception: une section descriptive étude des installations de radiologie au Nigeria. Sujets et méthodes: Radiologues de neuf établissements publics et de quatre établissements privés qui ont participé aux patients COVID-19 ont été invités à remplir des questionnaires sur les défis rencontrés et leurs stratégies d'adaptation. Les réponses ont été envoyées par courrier électronique. Analyse statistique utilisée: Les données des réponses ont été analysées à l'aide de Microsoft Excel pour Mac 2011 et présentées sous forme de figures et de tableaux. Résultats: La majorité des établissements publics 7 (77,8 %) et privés 4 (100 %) ne disposaient d'aucun équipement dédié uniquement aux patients COVID-19. Sept (77,8 %) établissements publics se sont plaints d'un personnel inadéquat, d'une faible disponibilité des équipements de protection individuelle (EPI) 8 (88,9 %), et le manque de technologie pour la visualisation à distance 7 (77,8 %). La peur d'une infection croisée était un défi dans l'un des établissements 1 (11,1 %). Faire faceles stratégies adoptées comprennent la réduction de la circulation dans le service en décourageant les patients sans rendez-vous et en annulant les cas non urgents, en réservant les cas suspects/confirmés pour des périodes plus légères, en utilisant un vieux film pour les écrans faciaux et un tissu pour les masques faciaux, la formation du personnel sur COVID-19 et mesures préventives et l'envoi de rapports aux médecins par courrier électronique. Conclusions: Il y a eu beaucoup de défis pendant la COVID-19 crise, les hôpitaux publics étant confrontés à plus de défis que les établissements privés. Les défis comprenaient entre autres l'insuffisance la force du personnel et le manque de technologie pour la visualisation à distance. Certains ont été surmontés grâce à l'éducation et à la production de masques faciaux/boucliers utilisant des matériaux recyclés. Mots-clés: défis, les stratégies d'adaptation, COVID-19, Nigeria.

Cervical Cancer Screening among HIV-Positive Women in Nigeria: An Assessment of Use and Willingness to Pay in the Absence of Donor Support.

INTRODUCTION: The sustainability of donor-supported cervical cancer screening for HIV-positive women in underresourced setting is a concern. The authors aimed to determine the willingness of HIV-positive women for out-of-pocket payment for the cancer screening, if necessary. METHODS: Questionnaires were administered to 400 HIV-positive women at the Adult HIV clinic, University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. RESULTS: In all 11 (2.8%) respondents were aware of Pap smear, but only 1 (9.1%) of them had used it. After cervical cancer screening counseling, 378 (94.5%) respondents were willing to pay for Pap smear, irrespective of the cost. This willingness showed no trend across marital or educational groups. Younger age of respondents was not associated with willingness to pay for Pap smear (odds ratio = 1.24; confidence interval 95%: 0.52, 2.94). CONCLUSION: Willingness to pay for Pap smear by HIV-positive women in Enugu, Nigeria, is high. This has implication for the program sustainability.

Trends of tuberculosis prevalence and treatment outcome in an under-resourced setting: The case of Enugu state, South East Nigeria.

BACKGROUND: The burden of tuberculosis (TB) in Nigeria is high. Unfortunately, the data from the TB programme of the States' ministries of health are usually unpublished, which possibly contribute to the prevailing ignorance and poor attitude of Nigerians to the disease. This study determined the trends of TB burden and treatment outcome in Enugu state, Nigeria; and relate the State's disease burden to that of the Nation. MATERIALS AND METHODS: A descriptive study of secondary data from the TB control programme, Ministry of Health, Enugu state, the National annual report of 2008, and World Health Organisation (WHO) TB database for the 10-year period of 2000-2009. RESULTS: The number of female TB cases was higher than males within the 0-14 age group only. The annual number of all TB cases showed a rising trend from 914 cases in the year 2000 to 1684 in 2009; but the proportion of new sputum smear (ss+) pulmonary tuberculosis (PTB) cases declined (Trend X(2) = 7.37, P = 0.007). The average number of extra-pulmonary TB cases increased fourfold from 2000-2004 to 2005-2009 (36 versus 150 cases). The median treatment success rate was 82% (range: 78-85). For the period 2004-2008, 2.0% of all new ss + PBT cases reported in Nigeria, originated from Enugu state. The proportion of new ss + PTB reported in Enugu state was significantly higher than national value (59.6% versus 52.6%) [P < 0.001, OR = 1.33 (95% CI: 1.26, 1.40)]. CONCLUSION: The burden of TB in Enugu state of Nigeria had increased over the period reviewed. However, the State's contribution to the disease burden in Nigeria was low.

Tuberculosis: a review of current concepts and control programme in Nigeria.

BACKGROUND: The burden of tuberculosis in Nigeria is the highest in Africa. Therefore, improved knowledge of health workers on the current issues concerning the disease, including the National guideline, is important for effective disease control. METHODS: An in-depth search of relevant literature on the subject area. This includes texts and operational documents of the Nigerian national tuberculosis programme, as well as online searches using Pubmed, Africanjournal online (Ajol), and Google scholar. RESULTS: About one third of the world population is infected with tuberculous bacilli with up to 10% lifetime risk of developing the disease. Pulmonary tuberculosis (PTB) especially the reactivated latent infection is the major source of the infection in communities. In an effort to increase case detection, a single acid fast bacillus in at least one of two sputum smears is currently adequate to diagnose PTB. Furthermore, there is a global effort to eliminate the disease by the year 2050 and these efforts are coordinated in Nigeria by the National tuberculosis controlprogramme. CONCLUSION: Tuberculosis is an impediment to human development in developing countries, especially in this era of HIV pandemic. Continuing education of health professional on tuberculosis and its accessible treatment, will improve patients' education, proper management and appropriate referral.

Adenomyosis and uterine rupture during labour in a primigravida: an unusual obstetric emergency in Nigeria.

The primigravid uterus is believed to be immune to rupture during labour. This may not be true for those who have had prior adenomyomectomy, hence this report. The patient was a 28-year-old nullipara who became pregnant 11 months after an adenomyomectomy. Twelve hours after vaginal delivery at term, she developed haemoperitoneum of unclear cause. Emergency laparotomy and subsequent histology showed a fundal complete uterine rupture through the adenomyomectomy site, which was repaired. It is concluded that adenomyomectomy predisposes a pregnant uterus to rupture during labour. Therefore, such women should be offered elective caesarean delivery at term.

Improved awareness of Pap smear may not affect its use in Nigeria: a case study of female medical practitioners in Enugu, southeastern Nigeria.

Improved awareness of Pap test by Nigerian women may not necessarily increase its use. This hypothesis was tested using female medical practitioners in Enugu state, Nigeria. They were expected to be advocates of disease screening and therefore should lead by example. All respondents were aware of the Pap smear but only 18% had used it. The mean frequency of Pap smear was 1.8+/-1.2 (range 1-5). Repeat Pap tests were observed only among respondents that had screened as routine. The majority (32%) of those who never screened for cervical cancer had no reason. There may be more to the use of Pap smear among women in Nigeria than its awareness.

An unmet cancer screening need of HIV-positive women in southeastern Nigeria.

CONTEXT: HIV infection and cervical cancer are common in Nigeria. HIV-positive women have a higher risk for cervical neoplasm; therefore, counseling and regular cervical cancer screening are recommended. After post-HIV testing counseling, HIV-positive women should be aware of the Papanicolaou (Pap) smear. OBJECTIVE: To determine the coverage of cervical cancer screening information for HIV-positive women by the post-HIV testing counseling. METHODS: Questionnaires were administered to 150 HIV-positive women and 150 HIV-negative controls after post-HIV testing counseling at the voluntary counseling and testing clinic of University of Nigeria Teaching Hospital, Enugu, Nigeria. Proportions of responses were compared by using a chi-square test at a 95% confidence level. RESULTS: Thirty-three (22.0%) HIV-positive women and 57 (38%) HIV-negative women were aware of cervical cancer. The awareness of the Pap smear among HIV-positive women (4.0%) was lower than that of HIV-negative women (21.3%) (P < .001). However, this finding became insignificant after adjustment for educational status groups (P > .05). No respondent agreed to being informed of Pap smears during post-HIV testing counseling. After counseling on cervical cancer, 96.0% of the HIV-positive group and 98.7% of the HIV-negative group expressed willingness to undergo routine Pap screening. CONCLUSIONS: Cervical cancer screening information is not part of post-HIV testing counseling for women in Enugu, southeastern Nigeria.