Joseph Olusesan Fadare

Knowledge of medical ethics among Nigerian medical doctors.

Background: The knowledge of medical ethics is essential for health care practitioners worldwide. The main objective of this study was to evaluate the knowledge of medical doctors in a tertiary care hospital in Nigeria in the area of medical ethics. Materials and Methods: A cross-sectional questionnaire-based study involving 250 medical doctors of different levels was carried out. The questionnaire, apart from the bio-data, also sought information on undergraduate and postgraduate training in medical ethics, knowledge about the principles of biomedical ethics and the ethical dilemmas encountered in daily medical practice. Results: One hundred and ninety (190) respondents returned the filled questionnaire representing a response rate of 76%. One hundred and fifty-two respondents (80%) have had some sort of medical ethics education during their undergraduate level in the medical education. The median duration of formal training or exposure to medical ethics education was 3.00 hours (range: 0-15). One hundred and twenty-nine respondents have read at least once the code of medical ethics of the Medical and Dental Council of Nigeria while 127 (66.8%) have some general knowledge of the principles of biomedical ethics. The breakdown of the identified ethical dilemmas shows that discharge against medical advice was the most identified by the respondents (69.3%) followed by religious/cultural issues (56.6%) while confidentiality was recognized by 53.4%. Conclusion: The knowledge of medical ethics by Nigerian medical doctors is grossly inadequate. There is an urgent need for enhancement of the teaching of the discipline at both undergraduate and postgraduate levels in Nigeria.

Unmet needs in asthma treatment in a resource-limited setting: findings from the survey of adult asthma patients and their physicians in Nigeria

Introduction The prevalence of asthma in our society is rising and there is need for better understanding of the asthma patients’ perception and treatment practice of physicians. The study was aimed at determining asthma attitudes and treatment practices among adult physicians and patients in Nigeria, with the goal of identifying barriers to optimal management. Methods To assess asthma attitudes, treatment practices and limitations among adult physicians and patients in Nigeria, a questionnaire survey was conducted among 150 patients and 70 physicians. Results Majority (66.7%) of the patients reported their asthma as moderate to severe, 42.7% had emergency room visit and 32% had admission due to asthma in the previous 12 months. Physicians and patients perceptions significantly differed in the time devoted to educational issues (31.4% vs.18.7%) and its contents: individual management plan (64.3% vs.33.3%), correct inhaler technique (84.0% vs.71.0%), medication side effects (80.0% vs.60.0%) and compliance 100% of time (5.7% vs. 18.7%). Patients reported that non-compliance with medication causes increased symptoms (67.0%), exacerbations (60.0%), bronchodilator use (56.0%), urgent physician visit (52.0%) and hospitalizations /ER visits (38.7%). Asthma medication in patients caused short term (10.7%) and long term side effects (20.0%). Due to side effects, 28.0% skipped and stopped their medications. Most physicians (85.7%) and patients (56.0%) agreed on the need for new medication options. The need for new medication in patients was strongly related to asthma severity, limitation of activities, side effects, cost and lack of satisfaction with current medication. With the exception of pulmonologists, physicians did not readily prescribe ICS and their prescriptions were not in line with treatment guidelines. Conclusion This study has highlighted the gaps and barriers to asthma treatment which need to be addressed to improve the quality of care in Nigeria.

Chloroquine-induced Acute Dystonic Reactions after a Standard Therapeutic Dose for Uncomplicated Malaria

Acute dystonic reactions (ADR) are extrapyramidal effects that usually occur after the initiation of a wide variety of drugs or triggering factors besides neuroleptics. We report the case of a 54-year-old man who was admitted with an approximately 10-hour history of muscle twitching around the eyes, face and neck after he took the first dose of oral chloroquine phosphate (1 g [600 mg base]) prescribed for uncomplicated malaria. He was given intravenous diazepam (10 mg statum) followed by 10 mg of oral diazepam 3 times a day. The symptoms improved within 30 minutes of treatment, and he was discharged 14 hours later after a complete recovery.

Discharge against medical advice: Experience from a rural Nigerian hospital

Introduction: Discharge against medical advice (DAMA) is a worldwide problem with negative health and socioeconomic effects. Factors that have been implicated as causes or contributing to DAMA include financial constraints, lack of health insurance, deteriorating clinical condition of the patient, and problematic doctor-patient relationships. Aims: determine the incidence and profiles ofDAMA on the medical wards, so as to allows for evidence-based interventions to reduce this problem to a minimum. Materials and Methods: This was a case-control study carried out on the medical wards of Federal Medical Center, Ido-Ekiti, South-West Nigeria. The medical records of all patients admitted to the male and female medical wards between January 2008 and April 2011 were reviewed. After being identified through the admission/discharge log, patients who were DAMA and a similar number of patients with regular discharge had their case notes retrieved. Information extracted included bio-data, diagnosis, duration of hospital stay, and reason for discharge. Results: One hundred and thirty-eight patients representing 7.2% were DAMA during the study period. Ninety five cases had complete medical records, and full analysis was carried out on these and 94 other cases with regular discharge as control. The mean age of the DAMA cases was 50.8 ± 18.3 years, with 58 (61.1%) of these patients being male; while the mean age of the control group was 54.1 ± 16.5, of which 54 (57.4%) were male. The mean duration of admission for patients with DAMA was 10.4 ± 9.2 days as against 11.9 ± 10 in the control group, a difference that is not statistically significant. The associations between type of discharge, sex, and duration of admission are shown through odds ratios of 0.883 and 0.833 respectively. Financial problems (48%), lack of clinical improvement (28.8%) and leaving to seek alternative/complimentary medical care (23.1%) were the factors found to be responsible for DAMA in the study. Conclusion: The incidence of discharge against medicine is high in this study. There is a need for all stakeholders to evaluate factors responsible for DAMA, with the aim of reducing this trend.

Discharge against medical advice: Ethico-legal implications from an African perspective

Results. The conflict between the professional values (beneficence) of the physician and the autonomy (self-determination) of the patient is the most prominent ethical dilemma in cases of DAMA. The issue of DAMA is more complicated in developing countries, especially because of communal models of decision making. One important ethical dilemma is the rationing of hospital admissions, especially for chronic conditions with poor prognosis. We have suggested a communal model for dealing with the issues. The main legal issue found in this review is the possibility of medical doctors being sued for medical malpractice. Conclusion. DAMA is associated with numerous ethical and legal issues of which physicians need to take cognizance.

Prevalence of Depression and Anxiety Disorders in People Living with HIV/AIDS in a Tertiary Hospital in South Western Nigeria

Background: In sub-Saharan Africa, HIV/AIDS constitutes a major burden with its attendant mental health related challenges. The aim of this study was to determine the prevalence of depression and anxiety disorder among HIV patients attending a tertiary institution in south western Nigeria. Method: A cross-sectional study conducted among HIV patients attending HIV/AIDS clinic of the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. A semi-structured questionnaire was administered to collect socio-demographic characteristics with the incorporation of Hospital anxiety depression questionnaire to assess the prevalence of depression and anxiety in the study and control groups. Results: A total of 424 HIV positive study participants were recruited. A corresponding age and sex matched 429 control subjects were also enrolled. The mean age of HIV positive patients and controls are 42.2 ± 9.5 years and 43.4 ± 12.4 years respectively. There was a female prepondence among both study populations. The prevalence of depression among PLHIV was 39.6% whereas depression was lower in the (22.0%) control group. Likewise anxiety was reported in PLHIV and control group as 32.6% and 28.7% respectively. Female gender, illiteracy, being divorced/widowed, unemployed and low income and low CD4 count were associated with depression while factors associated with anxiety disorder included lower age, female gender, low income, and low CD4 count. Conclusion: The prevalence of depression and anxiety are high in the HIV patients, hence proper integration of mental health care into the HIV programme is inevitable to give patients holistic care.

Respiratory-Related Medical Admissions in a Tertiary Institution in South-Western Nigeria

Background: Globally, respiratory diseases are common causes of medical admissions. Our objective was to determine the causes and outcome of respiratory diseases in our facility for health planning, policy formulation and allocation of resources.Method: A retrospective study of all respiratory-related admissions between January 2011 and December 2015. Classification of diseases was based on the ICD-10 coding system.Results: Respiratory-related admissions accounted for 460 (12%) of all medical cases with a slight male preponderance of 1.4 to 1. Mean age of patients was 50.4 ± 20.8 years. The majority 342 (74.3%) of these admissions were due to communicable respiratory diseases. Pulmonary tuberculosis (44.1%) and pneumonia (28.9%) accounted for the highest admissions which were closely followed by COPD (11.1%) and asthma (7.2%). The commonest co-morbidity was HIV/AIDS (12.3%) which also coexisted with other diseases in most cases of mortality. The median hospital-stay was 7 days. Most diseases had peak presentations during the dry season except bronchial asthma with rainy and dry peak seasons. The overall mortality was 17.6% and the highest mortalities were recorded in patients who had pulmonary tuberculosis (55.5%), pneumonia (20.9%) and COPD (8.6%).Conclusion: Communicable respiratory diseases are the leading causes of morbidity and mortality. Scaling up on coverage of the control programmes as well as the methodical integration of non-communicable diseases into already existing control programmes will further strengthen the health-care systems in resource-limited settings.