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   Table of Contents - Current issue
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January-June 2019
Volume 17 | Issue 1
Page Nos. 1-30

Online since Monday, January 14, 2019

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PERSPECTIVE  

Clinical governance: Quality Health-Care System for 21st Century p. 1
Mustapha A Danesi
DOI:10.4103/NJGP.NJGP_13_18  
Clinical governance is a system through which all organizations in the health system are accountable for continuously improving the quality of their clinical services and ensuring high standard of care by creating a facilitative environment in which excellence flourishes. Clinical governance has not been an important component of healthcare delivery in Nigeria. Clinical Governance has become the most important component of health care system for the 21st century. The aim is that, health care should be safe, effective, patient centered, timely, efficient and equitable.
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ORIGINAL ARTICLES Top

Magnesium deficiency in hospitalized patients with hypokalemia p. 8
Abdullahi Mohammed, Ibrahim M Bello, Adamu Hassan
DOI:10.4103/NJGP.NJGP_12_18  
Background: When magnesium deficiency coexists with hypokalemia, it aggravates the hypokalemia, potentiates its adverse effects, and also renders it refractory to treatment. Despite the impact of magnesium deficiency on the clinical effects of hypokalemia, plasma magnesium is not routinely measured in patients with hypokalemia in our setting. Objectives: The objective of this study was to examine the frequency of hypomagnesemia among hospitalized patients with hypokalemia at a tertiary hospital in Northeastern Nigeria. Subjects and Methods: A cross-sectional analytical study carried out among 80 hospitalized patients (40 with hypokalemia and 40 with normal plasma potassium). Clinical details of the study individuals were obtained from hospital case notes. Plasma magnesium was measured, and the frequency of hypomagnesemia was compared between the two study groups. Results: The mean plasma magnesium was significantly lower in the hypokalemic group than in the normokalemic group (0.67 ± 0.05 vs. 0.81 ± 0.04 mmol/L, P < 0.05). The frequency of hypomagnesemia in the hypokalemic participants was higher than in normokalemic participants (52.5% vs. 22.5%). Hypomagnesemia was twice as likely to be found in the hypokalemic participants as in the normokalemic participants. Conclusions: Hypomagnesemia is common among hospitalized patients with hypokalemia in our setting. We recommend further studies, using larger sample size, which will identify clinical conditions that are frequently associated with the simultaneous occurrence of these two disturbances and determine the clinical value of routine measurement of magnesium in patients with hypokalemia in our setting.
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Health-seeking behavior of medical directors in Nigeria p. 12
Jide Onyekwelu
DOI:10.4103/NJGP.NJGP_8_18  
Introduction: Medical doctors get poor quality healthcare because they do not accept the patient's role to enable them receive appropriate quality care from their colleagues. They indulge in self-medication with its attendant untoward effects to their health. Medical directors occupy the highest echelon in the policy making hierarchy in any healthcare facility. This study aims at determining health seeking behavior of medical directors. This group can easily influence the behavior of doctors working under them. Methodology: This is a cross sectional study of sixty medical directors that attended the National Executive Council meeting of Association of General and Private Medical Practitioners of Nigeria (AGPMPN) in Lagos, February 2018. Sample size was determined from previous prevalence study and sixty was adequate. Self-administered structured questionnaire was used to elicit answers from participants and analysis was done with the Statistical Package for Social Sciences (SPSS) version 20. Results: Most of the medical directors, 38 (63.5%), are specialist family physicians and 46, (76.7%) are general practitioners. Almost half of them 28 (46.7%), do not have personal physicians that they consult for regular healthcare while half of those that consult their colleagues do so informally. Reasons for not consulting their colleagues range from “illness not perceived as serious, 14 (46.7%)”, through “lack of time to consult another doctor, 10 (33.1%)” to “not believing that another doctor can give the sick doctor better treatment than he can give himself, 2 (7.7%)”. All the medical directors, 60 (100%) self-prescribe drugs while 46, (76.7%) self-prescribe and self-interpret investigations. Most of them, 54 (90%) know that self-medication is unethical while 58 (96.7%), know that it can delay making appropriate diagnosis and worsen morbidity. All the participants, 60 (100%), are aware of the modification in the physicians' oath that requires that the doctor has to be healthy to give good care to his patients. Conclusion: Medical directors in Nigeria practice self-medication. Almost half of them do not have personal primary physician. Half of the medical directors that consult their colleagues do so informally. This practice goes on despite their knowledge that it is unethical for a doctor to treat himself and that self-medication is injurious to health. Recommendation: Medical directors should include discussion of health-seeking behavior as part of their agenda during meetings. This will be able to make them internalize the culture of good health-seeking behavior and cascade it down to their junior colleagues in their establishments.
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Knowledge and practice of disease notification among private medical practitioners in Osun State, Southwestern Nigeria p. 16
Wasiu Olalekan Adebimpe, Adeolu Sunday Oluremi
DOI:10.4103/NJGP.NJGP_3_18  
Introduction: Disease surveillance and notification (DSN) in Nigeria had been largely public sector driven. This study assessed knowledge and practice of the private health-care facilities in DSN and explored models for private sector engagement DSN of communicable diseases in Southwestern Nigeria. Materials and Methods: A descriptive cross-sectional study was carried out among medical directors of 60 private health-care facilities in Osun State, using a semi-structured self-administered questionnaire. Data were analyzed using the SPSS software version 17.0. Results: All the respondents have heard about DSN, while 80% had good knowledge of DSN. Thirty-two (53.3%) of facilities have ever notified the Local Government Authorities (LGA) health authority, 23 (38.3%) of facilities notified in the last 3 months, while 54 (90.0%) were willing to participate with government on DSN. Only 9 (15.0%) regularly share their disease prevalence data with government on monthly basis. Recommendations to circumvent listed barriers to public–private participation were suggested by the respondents. Predictors of a good notification practice include having good knowledge score of DSN, having received feedback from government or notified centers, and having a designated DSN officer. Conclusions: High awareness and knowledge but poor practices of DSN were recorded. Reasons for not reporting were surmountable while recommendations given were feasible toward engaging the private sector toward improvement of DSN in Nigeria.
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Investigation of malaria by microscopy among febrile outpatients of a semi-rural nigerian medical center: What happened to malaria control programs? p. 23
Godpower Chinedu Michael, Ibrahim Aliyu, Umma Idris, Haliru Ibrahim, Obadire Samuel Olalere, Bukar Alhaji Grema, Monsur Ajibola Shittu, Sunday Abah
DOI:10.4103/NJGP.NJGP_5_18  
Background: Older reports estimate that malaria accounts for 60% of outpatient clinic encounters in Nigeria. However, current estimates suggest that malaria control programs have considerably reduced malaria-related morbidity and mortality on a global scale. The extent to which these programs impacted malaria prevalence in endemic countries such as Nigeria after the Millennium-Development Goals era may not have been fully appreciated. This study, therefore, assessed how common malaria was among febrile patients attending a semi-rural medical center in Nigeria. Materials and Methods: This was a cross-sectional study involving 290 randomly selected general and pediatric outpatients (who fulfilled inclusion criteria) attending the Federal Medical Centre, Birnin Kudu in August 2016. It assessed participants' clinical features, insecticide-treated net usage and presence of malaria parasitemia (confirmed by microscopy). Results: Participants' overall mean age was 18.4 ± 16.3 years (ranging from 0.25–62.0 years); 146 (50.3%) were females; 73.4% used insecticide-treated-net the previous night. Their mean overall temperature was 37.7°C ± 1.1°C. Overall malaria prevalence was 65.5%; however, the incidence was highest in ≥15 years age-group (30.3%) followed by ≤4 years age group (20.7%). Clinical features predicting malaria parasitemia were pallor (odds ratio [OR] = 5.03, 95% confidence interval [CI] = 1.96–14.42) and history of convulsion (OR = 4.06, 95% CI = 1.53–10.78). Their median parasite density was 1 ± 1.3. Clinical features poorly predicted malaria parasite density among participants. Conclusion: The malaria prevalence in this study was worryingly high. There is a need to review or modify current malaria control programs using more comprehensive strategies if reduction in the malaria-related morbidity and mortality in this and similar settings is desired.
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