Subcutaneous Emphysema Complicating the Convalescent Stage of Measles in a Malnourished Indigent Child: A Case Report From North-Western Nigeria.

Measles is a highly infectious, vaccine-preventable viral disease that runs a devastating course in developing countries due to its association with malnutrition and poor immunization coverage. Subcutaneous emphysema (SE) is a rare complication of measles that can be challenging to manage and may portend poor outcomes if untreated. We present a case of a two-year-old unimmunized rural dweller who presented with facial, neck, and chest swellings three days after being managed for measles exanthem from a referral hospital. Clinical findings were consistent with massive SE comorbid with malnutrition complicating the convalescent stage of measles. The child failed to improve with conservative management but responded to closed thoracostomy tube drainage (CTTD) through an underwater seal bottle with intermittent negative pressure wound therapy (NPWT). The child spent 47 days in the hospital during which the social welfare unit of the hospital supported the treatment. SE is a rare complication of measles infection that can be challenging to manage, especially when comorbid with malnutrition in an indigent child. The application of a multidisciplinary team approach and the use of CTTD with NPWT may shorten the duration of hospital stay for the patient.

Next-generation phenotyping in Nigerian children with Cornelia de Lange syndrome.

Next-generation phenotyping (NGP) can be used to compute the similarity of dysmorphic patients to known syndromic diseases. So far, the technology has been evaluated in variant prioritization and classification, providing evidence for pathogenicity if the phenotype matched with other patients with a confirmed molecular diagnosis. In a Nigerian cohort of individuals with facial dysmorphism, we used the NGP tool GestaltMatcher to screen portraits prior to genetic testing and subjected individuals with high similarity scores to exome sequencing (ES). Here, we report on two individuals with global developmental delay, pulmonary artery stenosis, and genital and limb malformations for whom GestaltMatcher yielded Cornelia de Lange syndrome (CdLS) as the top hit. ES revealed a known pathogenic nonsense variant, NM_133433.4: c.598C>T; p.(Gln200*), as well as a novel frameshift variant c.7948dup; p.(Ile2650Asnfs*11) in NIPBL. Our results suggest that NGP can be used as a screening tool and thresholds could be defined for achieving high diagnostic yields in ES. Training the artificial intelligence (AI) with additional cases of the same ethnicity might further increase the positive predictive value of GestaltMatcher.

COVID-19 vaccine acceptance among pregnant women: a multicentre cross-sectional survey in Port Harcourt, Nigeria.

Introduction: effective COVID-19 vaccines for the prevention of severe illness have been available for more than one year now. This study was carried out to ascertain vaccine hesitancy and its associations among pregnant women receiving antenatal care in Port Harcourt, a large cosmopolitan town in Nigeria. Methods: we conducted a cross-sectional online survey over 2 months among consenting pregnant women receiving antenatal care in the 3 largest obstetric service centers in Port Harcourt to evaluate COVID-19 vaccine hesitancy and its associations. Results: the prevalence of vaccine hesitancy was 669 (72.2%). Of the respondents, 27 (2.9%) had been infected or had a close family member infected with SARS-CoV-2, and 897 (96.8%) of them had heard of the COVID-19 vaccine; however, only 133 (14.4%) had been vaccinated against COVID-19. The safety of the mother in 260 (32.8%) and the safety of the unborn baby in 114 (14.4%) of the respondents were the reasons for vaccine hesitancy. A small proportion of women 7(0.9%) were hesitant on religious grounds. Tertiary education, use of childhood immunization for previous infants delivered, and availability of COVID-19 vaccine in the antenatal clinic at no cost to the women, were statistically significant predictors of vaccine uptake among the respondents. Conclusion: the prevalence of vaccine hesitancy among pregnant women in Port Harcourt was 72.2%. Higher academic achievement and availability of the COVID-19 vaccine in the antenatal clinic were predictors of vaccine uptake, while reasons for hesitancy were mostly due to safety concerns for the mother and unborn baby.

Urbanization effects on growth and otolith asymmetry in Chrysichthys nigrodigitatus and Oreochromis niloticus within tropical coastal lagoon watersheds.

In this study, we investigated the growth dynamics and otolith shape asymmetry of two fish species, Chrysichthys nigrodigitatus (CN) and Oreochromis niloticus (ON), within urbanized watersheds of the southern lagoon system, Nigeria. Using the von Bertalanffy growth model (VBGM), in addition to sediment metal concentration indices such as the average shale content, index of geoaccumulation (Igeo), contamination factor (CF), pollution load index (PLI), and potential ecological risk (PER) index, contamination levels were classified, and ecological risks were assessed. Notably, a lower growth potential (t0) was observed in CN at Ikorodu than at Epe, with similar trends for ON in the Epe during the dry season. Otolith asymmetry patterns, particularly in the CN at Ikorodu and ON in the Epe during the dry season, exhibited distinct ecological variations, indicating heightened stress levels at Ikorodu. Sediment analyses revealed moderate to strong contamination (Cd, Pb, Ni, and Cr) in both Lagos Lagoon (Ikorodu) and Epe Lagoon, with Ikorodu exhibiting notably high to moderate contamination levels according to the CF index. Elevated PLI values for Cd and Pb in Ikorodu, in addition to greater PER, indicated increased risk, with Cd posing a high risk (61.42%) and Pb posing a moderate risk (49.50%). Additionally, the reduced asymptotic length in the Epe during the dry season suggests that Chrysichthys nigrodigitatus is adaptable to seasonal variations, while divergent growth patterns in both areas indicate the existence of trade-off mechanisms in response to changing conditions. Habitat-specific otolith asymmetry and metal contamination underscore species adaptability, with wider stressor variability in Lagos than in Epe. Furthermore, multidimensional scaling analysis highlights the intricate relationship between otolith shape variables and environmental factors, emphasizing the need for tailored conservation efforts in urbanized watersheds.

Knowledge, perception, attitude, and practice of complementary and alternative medicine by health care workers in Garki hospital Abuja, Nigeria.

BACKGROUND: Healthcare workers are currently making efforts to offer services that cater to the holistic care needs of their patients. Previous studies have shown that some healthcare workers encounter challenges when advising patients about Complementary and Alternative Medicine (CAM), even though its use is widespread. Many health care workers may not have received formal education or training in CAM and consequently are unable to address their patients' questions about it. This study explored the knowledge, perception, attitude and practice of CAM by healthcare workers in Garki Hospital, Abuja, Nigeria. METHODS: This was an institution-based cross-sectional study, design and a convergent parallel, mixed methods design was used for data collection. Five (5) healthcare workers were purposively selected as participants for the key informant interviews, while two hundred and fifty (250) selected using a simple random sampling method completed the questionnaire. The data collection instruments used were a key informant interview guide and a 35-item self-administered questionnaire. Knowledge was assessed with a 4-item scale with a maximum score of 8. Perceptions and attitudes were assessed using Likert scales with a maximum score of 45 and 20, respectively. Practice was assessed with a 6-item scale with a maximum score of 18. Qualitative data was analysed using framework analysis. Quantitative data was analysed using descriptive and inferential statistics. Data acquired from both methods were integrated to form the findings. RESULTS: The average age of respondents for the quantitative study was 34.0 ± 7.8 years, and they were predominantly females (61.2%) with one to ten years of work experience (68.8%). The mean knowledge, perception and attitude scores were 1.94 ± 1.39, 13.08 ± 2.34 and 32.68 ± 6.28, respectively. Multiple linear regression result showed that knowledge (t = 2.025, p = 0.044) and attitude (t = 5.961, p = 0.000) had statistically significant effects on the practice of CAM. Qualitative data revealed that the majority of the participants perceive CAM favourably, provided it is properly introduced into mainstream medicine with evidence of safety and research to prove its efficacy. CONCLUSION: The study has shown the gaps in knowledge and the practices of CAM by conventional medical practitioners. This has implications for their ability to counsel and refer patients who may require CAM therapies. Policy, research and programmatic initiatives that seek to enhance their knowledge of CAM, and improve collaboration with CAM practitioners are recommended.

Evaluating the factor structure, reliability and validity of the Copenhagen Burnout Inventory-Student Survey (CBI-SS) among faculty of arts students of Ekiti State University, Ado-Ekiti, Nigeria.

The Copenhagen burnout inventory-student survey (CBI-SS) has shown promising psychometric properties in diverse student populations. This study aims to investigate the psychometric properties of the Nigerian version of the CBI-SS. This was a cross-sectional study of 635 students from Ekiti State University, Ado-Ekiti, Nigeria. Confirmatory factor analysis (CFA) was utilized to assess the CBI-SS validity. The reliability score of the CBI-SS was 0.957, ranging from 0.862 to 0.914 for the subscales. Correlation coefficients among the four CBI-SS factors ranged from 0.507 to 0.713. The CFA indicated an adequate goodness-of-fit for the four-factor model of the CBI-SS with the sample data. However, Item 10 was removed due to unacceptably low Average Variance Extracted score. The four factors demonstrated a negative correlation with both General Academic Self-Efficacy Scale and Cumulative Grade Point Average. Furthermore, both self-reported burnout and perceived course stress showed associations with the CBI-SS, where lower levels of burnout corresponded with lower median scores on the CBI-SS scales. This study underscores the significance of the CBI-SS in evaluating student burnout within our student population. The findings indicate that the CBI-SS is a highly reliable and valid instrument for assessing student burnout, suggesting its potential for effective utilization in the Nigerian academic context.

Impact of positive selection technology on seed yam productivity.

Positive Selection (PS) technique has been shown to reduce virus infection and increase yields, however there is insufficient empirical evidence on how this technology affects seed yam farm productivity. This study employed Propensity Score Matching (PSM) technique to evaluate the impact of PS on seed yam yields of 368 farmers randomly selected from Ghana and Nigeria. The findings showed that educational attainment, distance from the farm to the nearest market, cropping patterns, and other factors influenced farmers' adoption of PS. Furthermore, the adoption of PS technology resulted in a 16.98 % boost in farm productivity for PS seed yam farmers compared to their productivity without the technology. It is of the utmost importance that PS adoption be supported by developing tailored training materials for farmers to improve their use of the PS technology.

Entrepreneurship and innovation in Nigerian universities: Trends, challenges and opportunities.

In a bid to improve entrepreneurial outcomes of graduates from Nigerian universities, the Nigerian government has launched a range of interventions, including a 2004 national policy mandating compulsory inclusion of entrepreneurship education in the curriculum, and support for the establishment and implementation of entrepreneurship development activities by university departments. However, not much is known about the operational nuances, challenges and impact cases that characterise the implementation of this national policy in such a vast, culturally diverse country as Nigeria. To address this lacuna, this study draws on qualitative data from five focus groups, crystalised with quantitative data from 151 students across four Nigerian Universities, to explicate the current trends, successes, and challenges of entrepreneurship development and innovation support in Nigerian universities. The paper offers recommendations on how the current policy on entrepreneurship education in Nigeria can be enhanced to improve student entrepreneurial aspirations and outcomes. It also signposts innovative pedagogic activities which could be deployed to achieve this.

Surgical Residency Training in Nigeria: An Audit Through the Lenses of the Trainee and Trainer.

INTRODUCTION: Resident doctors constitute an important workforce of the Nigerian healthcare system wherein they undergo structured training to become competent specialists in different fields of medicine. The aim of this survey was to audit the surgical residency training process, incorporating both the trainer's and the trainee's perspectives, with a view to improving both residency training and overall patient care. METHODS: This was a multicenter descriptive cross-sectional study involving consultant surgeons and surgical trainees in selected tertiary healthcare institutions in Nigeria. A link to an online semi-structured and pretested questionnaire was sent to study participants whose agreement to fill out the questionnaire was taken as implied consent for the study. The perception of respondents on key areas of surgical residency training like the quality of training, skill acquisition, mentorship, supervision, operative exposures, research, funding, didactic sessions, and work schedule was assessed using a Likert scale. Their perceived challenges to training and measures to improve the quality of training were recorded. Data were analysed using version 23 of the SPSS. RESULTS: A total of 127 participants (25 trainers and 102 trainees) were recruited with a mean age of 34.8 ± 3.5 y for the trainees and 47.5 ± 6.9 y for the trainers. The majority of both the trainers and trainees (72%, n = 18 and 93%, n = 96, respectively) were dissatisfied with the quality of surgical residency training in Nigeria with the trainers (88%, n = 22) and trainees (97.1%, n = 99) mostly agreeing that surgical training should be standardized across training centres in Nigeria. The trainees and trainers rated mentorship, research, funding, and overall quality of surgical residency training as inadequate, while most of the trainees and trainers rated supervision of trainees as adequate. The trainees predominantly identified poor training facilities as the most important challenge to surgical residency, followed by high clinical workload, while the majority of the trainers identified workplace bullying and high clinical workload as being the predominant factors. The nine-pronged recommendations by both the trainers and trainees to improve surgical training in Nigeria include mentorship program for trainees, funding of surgical residency training, provision of facilities and equipment for training, adequate supervision of trainees by trainers, job description and defined work schedule for trainees, health insurance of patients, overseas training of trainees during the residency program, improved remuneration of trainees, and adequate motivation of trainers. CONCLUSIONS: The quality of surgical residency training in Nigeria is perceived as suboptimal by trainees and trainers. Perceived common challenges to surgical residency training include poor training facilities, workplace bullying, and high clinical workload. Adequate funding of surgical residency program, standardized mentorship, and training of trainees with improved remuneration of trainees and motivation of their trainers would enhance the overall quality of surgical residency training in Nigeria.

Seroprevalence and co-infection of HBV, HCV, and HIV among patients visiting selected hospitals in Anyigba, Kogi State.

Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Human Immunodeficiency Virus (HIV) remain a public health challenge globally. This study determined the prevalence and coinfection of HBV, HCV, and HIV among patients visiting Maria Goretti Hospital, Grimard Catholic Hospital, and Good News Hospital Anyigba, Kogi State. In a cross-sectional study, sera samples collected from 400 consenting patients were screened for HBV, HCV, and HIV using commercial immunodiagnostic test kits. Of the 400 subjects, 12 (3.0%), 4 (1.0%), and 16 (4.0%) were infected with HBV, HCV, and HIV, respectively. One participant was co-infected with HCV and HIV, while none was simultaneously infected with HBV and HIV. Participants aged 11-20 years had higher hepatitis B-surface antigenemia, while ages 21-30 years and 31-40 years had higher prevalence of HCV and HIV, respectively. Contrary to HBV and HCV positivity, HIV seropositivity was significantly predicted by the ages of exposure (p = 0.002). Males and females were equally infected with HBV (3.0% each), while more males than females were infected with HCV (1.5%) and HIV (4.6%). However, the difference between the occurrence of viral infections and patients' sex was not significant (p > 0.05). The single participants were more predisposed to HBV while the married subjects had more HCV and HIV mono-infection. However, neither the occurrence of HBV nor HCV or HIV was significantly predicted by the marital status of the individuals (p > 0.05). Subjects with no formal education had a higher positivity rate of HCV and HIV compared to other levels of education, while the tertiary level of education had higher exposure to HBsAg. Occupationally, students were more predisposed to HBV and HCV, while the unemployed participants were more predisposed to HIV. However, neither education nor the occupation of participants was significantly related to any of the viral infections (p > 0.05). Lack of knowledge of disease prevention significantly influenced the occurrence of HBV (p = 0.02), HCV (p = 0.04), and HIV (p = 0.04). Conclusively, the status of HBV, HCV, and HIV infection is low compared with findings of previous epidemiological studies in the area. However, the continuous circulation of the three viral infections and the high disease occurrence in the poorly informed participants suggest the need for increased public health education about infection control and prevention strategies in the area.

Predictors of accessing seasonal malaria chemoprevention medicines through non-door-to-door distribution in Nigeria.

BACKGROUND: In Nigeria, seasonal malaria chemoprevention (SMC) is typically administered door-to-door to children under five by community medicine distributors during high transmission seasons. While door-to-door distribution (DDD) is exclusively employed in Nigeria as part of standard operating procedures of SMC programmes, some households access SMC through non-DDD channels, such as fixed-point distributions, health facilities, and private purchase. However, analysis of access to SMC medicines through non-DDD has been limited, with little evidence of its outcomes on adherence to the three-day complete course of SMC medicines and caregiver actions in the event of adverse reactions to SMC medicines. METHODS: Data were obtained from SMC end-of-round coverage surveys conducted in Nigeria in 2021 and 2022, including 25,278 households for the analysis. The proportion of households accessing SMC medicine through non-DDD and the distribution of various non-DDD sources of SMC medicines were described. Multivariate random-effects logistic regression models were performed to identify predictors of accessing SMC medicines through non-DDD. The associations between non-DDD, and caregiver-reporting of adherence to complete administration of SMC medicines and caregiver actions in the event of adverse reactions to SMC medicines were also assessed. RESULTS: Less than 2% (314/24003) of households accessed SMC medicines through non-DDD in the states surveyed. Over 60% of non-DDD access was via health facility personnel and community medicine distributors from different locations. Variables associated with non-DDD access included heads of household being born in the local state (OR = 0.68, 95% CI 0.47 to 0.90), households residing in the study state since the first cycle of the SMC round (OR = 0.39, 95% CI 0.17 to 0.88), households with high wealth index (OR = 1.36, 95% CI 1.01 to 1.82), and caregivers hearing about date of SMC delivery in the previous cycle (OR = 0.18, 95%CI 0.14 to 0.24). Furthermore, non-DDD was associated with reduced SMC adherence and higher caregiver non-reporting of adverse reactions to SMC medicines in children compared with DDD. CONCLUSION: This study provides evidence on the characteristics of households accessing SMC medicines through non-DDD and its potential negative outcomes on adherence to SMC medicine and adverse reaction reporting, underscoring potential implementation issues that may arise if non-DDD delivery models are adopted in SMC, particularly in places where DDD had been firstly used.

Navigating Nigeria's Health Landscape: Population Growth and Its Health Implications.

This comprehensive analysis examines the multifaceted impacts of population growth on public health in Nigeria. Drawing parallels with Omran's epidemiological transition model (that focuses on the intricate means that patterns of health and illness are changing, as well as the relationships that exist between these patterns and the sociological, demographic, and economic factors that influence them) and referencing experiences from Chile and Ceylon. The study highlights a substantial rise in Nigeria's population causing a double burden of infectious and non-communicable diseases, leading to higher morbidity, and mortality rates, increased healthcare costs, decreased productivity, and health inequalities, posing significant challenges to the country's healthcare system. Furthermore, the correlation between low education levels and health outcomes underscores the importance of addressing systemic deficiencies in Nigeria's educational sector. The article emphasizes the urgent need for strategic interventions to mitigate the adverse effects of population growth on health. Recommendations include revitalizing primary healthcare centers, fostering public-private partnerships to enhance healthcare accessibility, leveraging technological advancements like telemedicine, and promoting initiatives to improve nutrition and environmental sustainability. Moreover, prioritizing education on reproductive health and family planning emerges as a crucial strategy to manage population growth sustainably. In conclusion, the article underscores the imperative for collaborative efforts across sectors to navigate Nigeria's evolving health landscape amidst increasing population growth. By implementing targeted policies and interventions, Nigeria can strive toward achieving universal health coverage, enhancing health outcomes, and ultimately raising the standard of living for its populace.

Clinicopathological profile and management challenges of congenital encephaloceles in a tertiary hospital in southwest Nigeria.

PURPOSE: A congenital encephalocele is the herniation of intracranial contents through skull defects of various sizes. Depending on the site, content, and size, it is associated with significant morbidity and mortality in children. There is a paucity of recent and comprehensive local clinical data regarding this anomaly. Understanding the peculiarities, clinical-pathologic profiles, and management challenges will help prevent and effectively manage congenital encephalocele to improve outcomes. METHODS: This was a retrospective study of all cases of congenital encephalocele managed between July 2000 and December 2023 at a tertiary hospital in the southwest region of Nigeria. Relevant demographic, clinicopathological, and management data were retrieved and analysed. RESULTS: There were 31 females and 11 males. Their ages ranged from 3 hours to 24 years. Sixteen (35.3%) were delivered in a non-health facility. Birth asphyxia was reported in 5 babies. Few mothers (4.8%) used preconception folic acid. Anaemia (n = 5) and sepsis (n = 4) were the common preoperative morbidities. All patients had definitive surgery, with 18 operated on within the first month of life. Cerebrospinal fluid (CSF) leak was the most common postoperative complication and was significantly observed in the sincipital group (p = 0.018). Thirty-one patients (73.8%) presented for follow-up after surgery, and the mean follow-up duration was 26.6 weeks. Mortality was recorded in a patient (2.4%) due to Klebsiella meningitis. CONCLUSION: Congenital encephaloceles are relatively common in our setting. Therefore, there is a need to address the associated poor maternal and neonatal health conditions. Early surgery can be performed with a favourable outcome.

A Geospatial Analysis of the Availability, Distribution, and Accessibility of Neurosurgical Facilities, Workforce, and Infrastructure in Nigeria; and Projection Towards 2050.

OBJECTIVE: There has been a modest but progressive increase in the neurosurgical workforce, training, and service delivery in Nigeria in the last 2 decades. However, these resources are unevenly distributed. This study aimed to quantitatively assess the availability and distribution of neurosurgical resources in Nigeria while projecting the needed workforce capacity up to 2050. METHODS: An online survey of Nigerian neurosurgeons and residents assessed the country's neurosurgical infrastructure, workforce, and resources. The results were analyzed descriptively, and geospatial analysis was used to map their distribution. A projection model was fitted to predict workforce targets for 2022-2050. RESULTS: Out of 86 neurosurgery-capable health facilities, 65.1% were public hospitals, with only 17.4% accredited for residency training. Dedicated hospital beds and operating rooms for neurosurgery make up only 4.0% and 15.4% of the total, respectively. The population disease burden is estimated at 50.2 per 100,000, while the operative coverage was 153.2 cases per neurosurgeon. There are currently 132 neurosurgeons and 114 neurosurgery residents for a population of 218 million (ratio 1:1.65 million). There is an annual growth rate of 8.3%, resulting in a projected deficit of 1113 neurosurgeons by 2030 and 1104 by 2050. Timely access to neurosurgical care ranges from 21.6% to 86.7% of the population within different timeframes. CONCLUSIONS: Collaborative interventions are needed to address gaps in Nigeria's neurosurgical capacity. Investments in training, infrastructure, and funding are necessary for sustainable development and optimized outcomes.

The Epidemiology of Spinal Neurosurgery in Nigeria: A Systematic Review and Patient-Level Analysis.

OBJECTIVE: Spinal pathologies are prevalent in Nigeria, though epidemiological data remains sparse. This systematic review used pooled patient-level data from across the country to generate a standardized epidemiological reference. METHODS: Four research databases and gray literature sources were searched. Risk of bias assessment was conducted using Risk of Bias in Non-Randomised Studies - of Interventions and Cochrane's risk of bias tool. We descriptively analyzed all article metrics and statistically analyzed relevant data variables via paired t-test and χ2 independence tests (α = 0.05). RESULTS: One hundred twenty-seven articles, comprising a patient cohort of 8425 patients, were analyzed. Most were retrospective cohort studies (46.5%) and case reports/series (31.5%), with an overall moderate-high risk of bias. Most studies were published in the last 20 years. Most patients were male (∼2.5 males per female), with an average age of 43.2 years (±16.4). Clinical diagnoses spanned the breadth of spinal neurosurgery. Approximately 45.0% of patients had complete spinal impairment. Pain (41.7%) was the most reported presenting feature. X-ray (45.1%) was the most common investigation used. Intervertebral disc herniation (18.9%) was the most prevalent imaging finding on MRI. Most patients were managed nonoperatively (57.8%), with a favorable outcome in 27.4% of patients. Posttreatment complications included pressure sores, infection, and motor deficits. CONCLUSIONS: This systematic review and pooled analysis provide an epidemiological overview of spinal neurosurgery in Nigeria over the last 60 years and serves as a useful reference to direct future global research in this arena.

Assessing the Neurosurgical Capacity in Nigeria Using the Modified Neuro-PIPES Tool.

BACKGROUND: Like many low- and-middle-income countries in Africa, documented assessment of the neurosurgical workforce, equipment, infrastructure, and scope of service delivery in Nigeria is lacking. This study aimed to assess the capacity for the delivery of neurosurgical services in Nigeria. METHODS: An 83-question survey was disseminated to neurosurgeons and residents in Nigeria. We report the findings from the capacity assessment section of the survey, which used the modified neurological-PIPES (personnel, infrastructure, procedures, equipment, and supplies) (MN-PIPES) tool to evaluate the availability of neurosurgical personnel, infrastructure, procedures, equipment, and supplies. A comparative analysis was done using the domain and total MN-PIPES scores and MN-PIPES index. RESULTS: The national average MN-PIPES score and index were 176.4 and 9.8, respectively. Overall, the southwest and northwest regions had the highest scores and frequently had high subscores. The survey respondents reported that the main challenges impeding neurosurgery service delivery were a lack of adjunctive supplies (75.2%), a dearth of diagnostic and interventional equipment (72.4%), and an absence of a dedicated intensive care unit (72.4%). CONCLUSIONS: The availability of workforce, infrastructure, equipment, and supplies needed to provide optimal neurosurgical care is uneven in many institutions in Nigeria. Although major strides have been made in recent years, targeted collaborative interventions at local, national, regional, and international levels will further improve neurosurgical service delivery in Nigeria and will have positive ripple effects on the rest of the healthcare system.

Perceived Barriers to Pursuing a Career in Neurosurgery in Nigeria: A Cross-Sectional Survey of Nigerian Medical Students and Unspecialized Physicians.

BACKGROUND: Nigeria has an inadequate number of neurosurgeons to meet the population's demand for neurosurgical care. Furthermore, few Nigerian neurosurgeons are female. This study sought to evaluate perceived barriers to pursuing neurosurgery among Nigerian trainees. METHODS: A 60-question survey was distributed electronically to medical students at the College of Medicine, University of Ibadan, and unspecialized intern physicians at the University College Hospital, Ibadan, Nigeria. Participation was voluntary. RESULTS: One hundred fifty-seven respondents participated in the survey. A greater proportion of males indicated an interest in neurosurgery than females (40% vs. 18%, P = 0.010). Over 75% of respondents identified decreased family and personal time, long work hours, and limited access to maternity or paternity leave as potential barriers to neurosurgery, with no differences by gender. Respondents overall saw being female and low-income as disadvantageous to pursuing neurosurgery in Nigeria. Although they universally viewed research as important in neurosurgery, 59% of respondents reported inadequate access to research opportunities; this did not vary by gender. However, 65% of female respondents reported that having a female neurosurgery mentor would increase their interest in neurosurgery (vs. 37% of males, P = 0.001). CONCLUSIONS: Nigerian medical trainees perceived the time commitment of neurosurgery as a major barrier to pursuing the specialty. Regardless of gender, they also reported low exposure to neurosurgery and inadequate access to research and mentorship opportunities. However, we found that enhanced female representation among neurosurgery mentors and improved work-life balance could increase interest in neurosurgery and help expand Nigeria's neurosurgical workforce.

Women in Nigerian Neurosurgery: A Cross-Sectional Survey.

BACKGROUND: Although women have made remarkable strides in several medical specialties in Sub-Saharan Africa, their presence and contribution to the development of neurosurgery remain limited. We sought to study the gender differences within Nigerian neurosurgery, identify challenges resulting from these differences, and recommend how African female neurosurgeons can maximize their effects in neurosurgery. METHODS: A structured online survey captured data on neurosurgical infrastructural capacity, workforce, and training from neurosurgical consultants and residents in neurosurgical centers in Nigeria. All the collected data were coded and analyzed. RESULTS: Altogether, 82 neurosurgical consultants and 67 neurosurgical residents from 50 primary medical institutions in Nigeria completed the online survey. Only 8 of the respondents (5.4%) were women, comprising 3 consultants, 2 senior residents, and 3 junior residents. Although 40.2% of the respondents did not believe that being female affected the decision of whether to specialize in neurosurgery, 46.3% believed that being female was a disadvantage. Most did not believe that being female affected admission (57.8%), completion of a neurosurgery residency (58.5%), or life working as a neurosurgeon after graduation (63.4%). The most common challenges women face while navigating through neurosurgery training and practice are erosion of family and social life, lack of female mentors, and lack of a work-life balance. CONCLUSIONS: There is a deficit of both female consultants and trainees among Nigerian neurosurgeons. Identifying female medical students with a strong interest in neurosurgery and providing early mentorship might increase the number of female neurosurgeons.

Epidemiological Burden of Neurotrauma in Nigeria: A Systematic Review and Pooled Analysis of 45,763 Patients.

OBJECTIVE: Neurotrauma is a significant cause of morbidity and mortality in Nigeria. We conducted this systematic review to generate nationally generalizable reference data for the country. METHODS: Four research databases and gray literature sources were electronically searched. Risk of bias was assessed using the Risk of Bias in Non-Randomized Studies of Interventions and Cochrane's risk of bias tools. Descriptive analysis, narrative synthesis, and statistical analysis (via paired t-tests and χ2 independence tests) were performed on relevant article metrics (α = 0.05). RESULTS: We identified a cohort of 45,763 patients from 254 articles. The overall risk of bias was moderate to high. Most articles employed retrospective cohort study designs (37.4%) and were published during the last 2 decades (81.89%). The cohort's average age was 32.5 years (standard deviation, 20.2) with a gender split of ∼3 males per female. Almost 90% of subjects were diagnosed with traumatic brain injury, with road traffic accidents (68.6%) being the greatest cause. Altered consciousness (48.4%) was the most commonly reported clinical feature. Computed tomography (53.5%) was the most commonly used imaging modality, with skull (25.7%) and vertebral fracture (14.1%) being the most common radiological findings for traumatic brain injury and traumatic spinal injury, respectively. Two-thirds of patients were treated nonoperatively. Outcomes were favorable in 63.7% of traumatic brain injury patients, but in only 20.9% of traumatic spinal injury patients. Pressure sores, infection, and motor deficits were the most commonly reported complications in the latter. CONCLUSIONS: This systematic review and pooled analysis demonstrate the significant burden of neurotrauma across Nigeria.

Neurosurgical Practice, Training, and Research Capacity Assessment in Nigeria: A Methodological Approach.

OBJECTIVE: There has been a progressive growth of neurosurgery in Nigeria over the past 6 nulldecades. This study aims to comprehensively evaluate the state of neurosurgical practice, training, and research in the country. METHODS: We used a mixed-methods approach that combined a survey of neurosurgery providers and a systematic review of the neurosurgical literature in Nigeria. The 83-question online survey had 3 core sections for assessing capacity, training, and gender issues. The systematic review involved a search of 4 global databases and gray literature over a 60-year period. RESULTS: One hundred and forty-nine respondents (95% male) completed the survey (65.4%). Their age ranged from 20 to 68 years, with a mean of 41.8 (±6.9) years. Majority were from institutions in the nation's South-West region; 82 (55.0%) had completed neurosurgery residency training, with 76 (51%) employed as consultants; 64 (43%) identified as residents in training, 56 (37.6%) being senior residents, and 15 (10.1%) each held academic appointments as lecturers or senior lecturers. The literature review involved 1,023 peer-reviewed journal publications: 254 articles yielding data on 45,763 neurotrauma patients, 196 on 12,295 pediatric neurosurgery patients, and 127 on 8,425 spinal neurosurgery patients. Additionally, 147 papers provided data on 5,760 neuro-oncology patients, and 56 on 3,203 patients with neuro-vascular lesions. CONCLUSIONS: Our mixed-methods approach provided significant insights into the historical, contemporary, and future trends of neurosurgery in Nigeria. The results could form the foundation for policy improvement; health-system strengthening; better resource-planning, prioritization, and allocation; and more purposive collaborative engagement in Nigeria and other low- and middle-income countries.