Patient safety in a Resource-constrained Context: A cross-sectional study of experience, drivers, barriers and preventive measures for safety incidents and accidents amongst medical doctors in South-east Nigeria.

BACKGROUND: Globally, safety of patients in healthcare environment has been an issue of the decade, especially in resource-constrained settings. The Hippocratic maxim primum non nocere requires medical practitioners to give utmost importance to the principle of beneficence and safety in attending to patients. It is a current paradigm in quality of care metrics that determines what happens to patients who interface with the healthcare system. AIM: The study was aimed at describing the experience, drivers, barriers and preventive measures for patient safety incidents and accidents in a cross-section of medical practitioners in Abia State, Southeast Nigeria. PARTICIPANTS AND METHODS: This was a cross-sectional study carried out on 185 physicians in Southeast Nigeria. Data collection was done using a pre-tested, self-administered questionnaire that elicited information on experience, drivers, barriers and preventive measures for patient safety incidents. RESULTS: The mean age ± standard deviation of the respondents was 36 ± 5.6 years, with a range of 25-72 years. There were 163 (88.1%) males and 22 (11.9%) females. Lifetime and previous 1-year committal of patient safety incidents were 100% (185/185) and 61.0% (113/185), respectively, with the most committed safety incident being medication errors. The most common driver of patient safety incidents was physician stress and burnout (100%) (185/185), whereas the most common barrier was communication (100%) (185/185). The most common preventive measure was patient safety incident reporting system (100%) (185/185). One-year committal of patient safety incidents was associated with duration of practice <10 years (P = 0.00001) and sex (P = 0.011). CONCLUSION: Patient safety incidents occurred amongst the study participants, with the most committed safety incident being medication errors. The most common driver was physician stress and burnout. The most common barrier was communication and feedback barrier, whereas the most common preventive measure was patient safety incident reporting system. Patient safety information, education and training should be the target for continuing professional development in order to safeguard the health of the patients in healthcare environment.

Depression among ambulatory adult patients in a primary care clinic in southeastern Nigeria.

BACKGROUND: Depression is a global health problem that occupies eminent position in clinical and community mental health. As the global prevalence of depression increases, the sociomedical challenges associated with it increase, especially in resource-constrained environment. AIM: The study was aimed at describing depression among ambulatory adult patients in a primary care clinic in Southeastern Nigeria. PATIENTS AND METHODS: A cross-sectional descriptive hospital-based study was carried out on 400 adult patients in a primary care clinic of Federal Medical Centre, Umuahia. Data on relevant epidemiological variables were collected using pre-tested, structured interviewer-administered questionnaire. Patient Health Questionnaire-9 was used to assess for depression. Data were analysed using the Statistical Package for the Social Sciences software version 21. Test of associations was done using Chi-test and logistic regression, and P < 0.05 was considered statistically significant. RESULTS: The age of the study participants ranged from 18 to 78 years with mean age of 38 ± 9.2 years, and there were 40.5% males. The prevalence of depression was 48.5% with the most common type being mild depression (32.3%). Occurrences of symptoms were most frequent and severe in the home environment (59.8%) and during the night (62.9%). Hypertension (35.5%) and alcohol use (57.5%) were the most common medical condition and substance used, respectively. Depression was significantly associated with elderly age (P = 0.005), females (P = 0.017), physical inactivity (P = 0.039) and psychosocial stressors (P = 0.042). The most significant predictor of depression was elderly age (adjusted odds ratio = 2.50; 95% confidence interval [1.40-3.78]; P = 0.001). Older persons were three and half times more likely to have depression when compared to their counterparts who were younger. CONCLUSION: This study has demonstrated high prevalence of depression and some epidemiological factors in the occurrence of depression among the study participants. Depression occurred predominantly among the elderly, females, physically inactive, hypertensive and those who had psychosocial stressors. Occurrences of symptoms were most frequent at home and nighttime. The most commonly used substance was alcohol.

Proximate Family Biosocial Variables Associated with Severe Malaria Disease among Under-Five Children in Resource-Poor Setting of a Rural Hospital in Eastern Nigeria.

BACKGROUND: Malaria threatens the life of under-five in rural Nigerian families. Although, factors that influence malaria in under-five are manifold. However, family biosocial factors may contribute to the variability of the clinical picture. AIM: To determine proximate family biosocial variable associated with severe malaria among under-five children in a resource-poor setting of a rural hospital in Eastern Nigeria. MATERIALS AND METHODS: A cross-sectional study carried out on the families of under-five managed for malaria. Data extracted included family biosocial variables and diagnosis. An under-five child was defined to have malaria if the mother gave complaints of fever, vomiting, and other symptoms suggestive of malaria, had body temperature exceeding 37.5°C with the asexual forms of Plasmodium falciparum detected on the peripheral blood film. Severe malaria is the malaria that presents with life-threatening features like severe anemia and cerebral malaria. RESULTS: The prevalence of severe malaria was 31.8% The family biosocial variables significantly associated with severe malaria were maternal low level of education (P = 0.031), family size >4 (P = 0.044), low social class of the family (P = 0.025), nonliving together of parents (P = 0.011), and poor access to health facilities (P = 0.038). The most significant predictor of severe malaria was nonliving together of parents (P = 0.000, odds ratio = 3.08, confidence interval = 1.64-5.10). CONCLUSION: This study has demonstrated that some family biosocial variables are associated with severe malaria. These families should constitute at risk families that could be targeted for malaria interventional programs.