research topics in nursing in nigeria

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Nursing project topics & research materials | final year research project topics with free chapter one, 1. investigating the causes of infertility and attitude of couples towards infertil..., »   chapteer one introduction 1.1 background of the study infertility can result in significant psychosocial impairment due to the fact that reproduction is considered an essential human desire [khodakarami and hashemi, 2019]. infertility, as defined by the world health organisation, is a condition of the reproductive system characterised by the failure to conceive after one year of continuous sexu... continue reading ».

Item Type: Project Material  |  54 pages |  664 engagements | 

2. EFFECT OF DIARRHEA INFECTION ON THE HEALTH OF CHILDREN BETWEEN 0-5 YEARS OF AGE

» effect of diarrhea infection on the health of children between 0 5 years of age   chapter one introduction 1.1 background of the study in developing nations such as nigeria, elevated rates of mortality among young children are attributable to diarrhoea, notwithstanding global endeavours to enhance child health as a whole. annually, an estimated five million children below the age of five perish f... continue reading ».

Item Type: Project Material  |  54 pages |  571 engagements | 

3. CERVICAL CANCER SCREENING: AN EVALUATION OF ITS RELEVANCE TO FEMALE UNDERGRADUAT...

» cervical cancer screening: an evaluation of its relevance to female undergraduate student of  of alvan ikoku federal college of education owerri, imo state    chapter one introduction background of the study cervical cancer is the most prevalent gynaecological cancer among women globally. accounting for 13% of all female cancer infections and a significant cause of cancer related mortality (who... continue reading ».

Item Type: Project Material  |  54 pages |  433 engagements | 

4. PREVALENCE, RISK FACTORS, AND PREVENTION OF CERVICAL CANCER AMONG WOMEN OF REPR...

» prevalence,  risk factors, and prevention of cervical cancer among women of reproductive age in abeokuta, ogun state   chapter one introduction 1.1 background of the study the second most prevalent malignant tumor in women worldwide is cervical cancer, which poses a major threat to their health. it is a cancer arising from the cervix, in which the cells of the cervix become abnormal and start to... continue reading ».

Item Type: Project Material  |  54 pages |  53 engagements | 

5. EFFECT OF NURSES INTERPERSONAL COMMUNICATION SKILLS ON QUALITY OF CARE DELIVERY ...

»   chapter one introduction 1.1 background of the study communication helps the flow of knowledge from person to person and develop better interpersonal relationships [brinkert 2018]. communication is the exchange of information between people by sending and receiving it through speaking, writing or by using any other medium. clear communication means that information is conveyed effectively betwe... continue reading ».

Item Type: Project Material  |  54 pages |  752 engagements | 

6. AN ASSESSMENT OF THE PREVALENCE AND THE RISK CIRCULATION PREVENTION OF HIVAIDS I...

»   chapter one introduction background of the study the prevalence of hiv infection remains a significant health concern, with around 1.5 million new cases, 10.2 million untreated cases (out of a total of 37.7 million), and 680,000 aids related deaths reported globally in 2020. the hiv/aids pandemic has surpassed two decades in duration. in africa, the pandemic has disproportionately affected our ... continue reading ».

Item Type: Project Material  |  67 pages |  727 engagements | 

7. KNOWLEDGE OF RISK FACTORS AND CONSEQUENCES OF SELF MEDICATION AMONG STUDENT NURS...

»       chapter one introduction 1.1 background to the study to be in good health is an essential component of one’s life, having access to an efficient healthcare system in a community is important. most of the common health ailments are treated by the individual themselves without medical supervision, termed self medication (sm) (sharif, bugaighis, & sharif, 2015). according to world health o... continue reading ».

Item Type: Project Material  |  55 pages |  1,075 engagements | 

8. PREVALENCE, RISK FACTORS, AND PREVENTION OF CERVICAL CANCER AMONG WOMEN OF REPRO...

»   chapter one introduction background of the study the second most prevalent malignant tumor in women worldwide is cervical cancer, which poses a major threat to their health. it is a cancer arising from the cervix, in which the cells of the cervix become abnormal and start to grow uncontrollably, forming tumor. however, persistent infection of high risk human papillomavirus (hpv) has been clarif... continue reading ».

Item Type: Project Material  |  57 pages |  1,232 engagements | 

9. AN EXAMINATION ON THE NEGATIVE EFFECT OF RAPE EXPERIENCE ON WOMEN'S MENTAL HEALT...

»     chapter one introduction 1.1 background of the study a sexual act that carried out against the will of the person and may not necessarily involve direct physical contact is defined as sexual violence (sv). predominantly, it is perpetrated by a man against the women, and further, it also associated with some mental health problems including sleeping disorder, depression and anxiety, obsession... continue reading ».

Item Type: Project Material  |  54 pages |  1,944 engagements | 

10. AN ASSESSMENT OF NURSING MOTHER'S KNOWLEDGE AND ATTITUDE TOWARDS INFANT HEALTH C...

»   chapter one introduction 1.1 background of the study caring for infants can be challenging, especially for first time mothers. attitude of mothers towards caring for their infants has a major role in determining the nutritional status of children, maximizing the growth rate of a child at early years of life and has great potential for reducing under five malnutrition and thereby affecting child... continue reading ».

Item Type: Project Material  |  54 pages |  2,044 engagements | 

11. ASSESSMENT OF FACTORS THAT PROVOKED ABUSE OF NURSES BY PATIENTS’ RELATIVES IN ...

» teaching hospital         chapter one introduction background of the study the health sector is one of the key sectors and one of the workplaces most susceptible to abuse and violence. according to the international labour organization (ilo), health care employees have the second highest risk of workplace violence (ahmad, 2015). in 2012, the bureau of labor statistics reported a 6% rise in abu... continue reading ».

Item Type: Project Material  |  67 pages |  1,870 engagements | 

12. EFFECTIVENESS OF MANAGEMENT OF PATIENTS WITH HYPERTENSION IN SPECIALIST HOSPITAL...

»       chapter one introduction background of the study in general practice, hypertension presents itself rather often as a health problem. according to akepalakorn (2020), there were over 11 million persons in nigeria who had been diagnosed with hypertension, and data showed that there were over 600,000 new cases in the year 2012. (tonghong, 2022). in the emergency department, patients with ele... continue reading ».

Item Type: Project Material  |  54 pages |  1,429 engagements | 

13. ASSESSMENT OF AWARENESS OF PMTCT SERVICES AMONG PREGNANT WOMEN ATTENDING ANTENAT...

»   assessment of awareness of pmtct services among pregnant women attending antenatal clinic   chapter one: introduction 1.1 background of the study mother to child transmission (mtct) of hiv remains a major public health problem and continues to account for a substantial proportion of new hiv infections among young children [thara and srinivasan 2000; murphy 2002; botha et al. 2006]. the delive... continue reading ».

Item Type: Project Material  |  51 pages |  1,407 engagements | 

14. NURSES’ PERCEPTION OF THEIR NURSE MANAGERS’ DELEGATION OF RESPONSIBILITIES I...

» chapter one introduction 1.1 background of the study delegation of responsibility is one of the vital organizational processes which is inevitable along with the expansion and growth of a business enterprise (akrani, 2010). it is a management function that can be learned and horned to a fine edge by anyone who is willing to make some effort and able to get some practice (curtis & nicholl 2004). in... continue reading ».

Item Type: Project Material  |  59 pages |  2,635 engagements | 

15. THE INCIDENCE OF SEXUAL ABUSE AND UNWANTED PREGNANCIES AMONG TEENAGERS

» the incidence of sexual abuse and unwanted pregnancies among teenagers chapter one introduction 1.1    background of study sexual abuse is defined as the involvement of dependent, developmentally immature children in sexual activities that they do not fully comprehend and therefore to which they are unable to give informed consent and/or which violates the taboos of society. (mcdowell, m. 2002)... continue reading ».

Item Type: Project Material  |  57 pages |  0 engagements | 

16. SOCIO-ECONOMIC AND CULTURAL CORRELATES OF EXCLUSIVE BREASTFEEDING AMONG NURSING...

» socio economic and cultural correlates of exclusive breastfeeding among nursing mother chapter one introduction 1.0   background of the study adequate nutrition during infancy and early childhood is essential to ensure the growth, health, and development of children their full potential. it has been recognized worldwide that breastfeeding is beneficial for both the mother and child, as breast mi... continue reading ».

Item Type: Project Material  |  60 pages |  0 engagements | 

17. RELEVANCE OF BLOOD CULTURE TO THE DIAGNOSIS AND TREATMENT OF SEPTICEMIA

» relevance of blood culture to the diagnosis and treatment of septicemia chapter one introduction blood is normally sterile in healthy individuals. it is the main transport mechanism connecting all different parts of the body. as it serves as a transport system for oxygen, food materials, waste products and others round the body, it can also carry microbes (eugene et al., 1998).   however, it has... continue reading ».

Item Type: Project Material  |  56 pages |  0 engagements | 

18. INFLUENCE OF WORK-LIFE BALANCE ON THE PSYCHOLOGICAL DISTRESS AMONG NURSES IN OSU...

» influence of work life balance on the psychological distress among nurses in osun state chapter one introduction 1.1 background to the study the nursing profession has been known to be an integral part of the health care system, they are needed in all stages and levels of healthcare. the registered nurse is responsible for implementing the physicians’ orders, such as giving medications or changi... continue reading », 19. incidence of low birth weight among woman of child bearing age, » incidence of low birth weight among woman of child bearing age   chapter one introduction 1.1            background of the study birth weight is an important determinant of child survival and development. the world health organization (who) defined low birth weight (lbw) as weight at birth of less than 2,500 grams. this practical cut off for international comparison is based on epidem... continue reading ».

Item Type: Project Material  |  60 pages |  21 engagements | 

20. FACTORS INFLUENCING UTILIZATION OF PREVENTION OF MOTHER TO CHILD TRANSMISSION (P...

» factors influencing utilization of prevention of mother to child transmission (pmtct) services among pregnant women chapter one introduction 1.1       background of the study the universality of harmful beliefs and subsequent negative attitudes towards the mentally ill is not in doubt (thara and srinivasan 2000; murphy 2002; botha et al. 2006). this study is set out to identify the persisten... continue reading ».

Item Type: Project Material  |  54 pages |  0 engagements | 

21. EXAMINATION OF RISK BEHAVIOR FROM HARD DRUGS (METHAMPHETAMINE "MKPURUMMIRI") AMO...

» examination of risk behavior from hard drugs (methamphetamine "mkpurummiri") among the youths. a case study of umunneochi lga chapter one introduction 1.1 background of the study substances misuse among youths has been investigated for a long time, with the aim of specifically identifying and studying interventions that will minimize drug use in this group(1). information on the relationship betwe... continue reading ».

Item Type: Project Material  |  58 pages |  1,543 engagements | 

22. ACCESSIBILITY, USE, MISUSE AND EFFECTS OF COMBINED ORAL CONTRACEPTIVES AMONG WO...

» accessibility, use, misuse and effects of combined oral contraceptives among women of child bearing age chapter one introduction over the world, family planning and contraception is among the pertinent issues been discussed. in the early days, human societies had creation of as many children as possible, a central value. today however, relatively few societies can afford this perspective, resultin... continue reading ».

Item Type: Project Material  |  59 pages |  0 engagements | 

23. DETERMINING THE CAUSAL RELATIONSHIPS BETWEEN ADVANCED MATERNAL AGE AND DOWN SYND...

» determining the causal relationship between advanced maternal age and down syndrome chapter one introduction 1.1 background of study down syndrome is a genetic disorder caused when abnormal cell division results in an extra chromosome 21. this genetic disorder, which varies in severities cause lifelong intellectual disability and developmental delays and in some people it causes health problems. d... continue reading ».

Item Type: Project Material  |  60 pages |  1,318 engagements | 

24. CULTURAL BELIEFS AND GENDER DYNAMICS OF PMTCT SERVICE AMONG PREGNANT WOMEN

» cultural beliefs and gender dynamics of pmtct services among pregnant women chapter one introduction 1.1            background of the study in many communities in sub saharan africa, pregnancy is viewed as a ‘woman’s affair’, with a man’s role primarily to provide financial support. even where men view accompanying their partner to antenatal clinics or pmtct services as good pra... continue reading ».

Item Type: Project Material  |  58 pages |  1,314 engagements | 

25. CHILD LABOUR, CHILD TRAFFICKING AND GIRL CHILD MARRIAGES IN NIGERIA

» child labour, child trafficking and girl child marriage in nigeria chapter one introduction 1.1          background of the study child labour and trafficking are essentially understood as encompassing monetary or non monetary activities which are mentally physically, morally and socially hazardous for children below 15 years of age (unicef, 2005). child labour is any work that harms chil... continue reading ».

Item Type: Project Material  |  60 pages |  1,625 engagements | 

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NURSING PROJECT TOPICS AND RESEARCH MATERIALS

1. the impact of exclusive breastfeeding on infants 0-6 months in konshisha local g..., » chapter one introduction 1.1 background of the study breastfeeding is unequaled way of providing ideal food for the health, growth and development of infants and most natural way of feeding them in all traditions. it is an integral part of the reproductive process with important implications for the health of the mother. human milk is the most appropriate of all available types of milk, that is un... continue reading ».

50 pages |  190 engagements | 

2. ROLE OF EDUCATION AND TRAINING IN PROMOTING INFECTION CONTROL PRACTICE AMONG NUR...

» chapter one introduction 1.1 background of the study health care professionals are constantly exposed to microorganisms. many of which can cause serious or even lethal infections (twitchell, 2003). nurses in particular are often exposed to various infections during the course of carrying out their nursing activities (kosgeroglu, ayranci, vardareli, & dincer, 2004). hospital acquired infect... continue reading ».

50 pages |  191 engagements | 

3. ASSESSMENT OF HEMATOLOGICAL PARAMETER OF TUBERCULOSIS (TB) INFECTED PATIENTS AT ...

» chapter one introduction 1.1 background of the study tuberculosis (tb) is an infectious disease usually caused by the bacterium mycobacterium tuberculosis (mtb). tuberculosis generally affects the lungs, but can also affect other parts of the body. most infections do not have symptoms, in which case it is known as latent tuberculosis. about 10% of latent infections progress to active disease which... continue reading ».

40 pages |  249 engagements | 

4. FACTORS AFFECTING THE IMPLEMENTATION OF IMMUNIZATION

» chapter one introduction 1.1 background to the study it is obvious that immunization is one of the most cost effective public health interventions for reducing global child morbidity, mortality and life time disabilities (lee, 2003) (chen et al, 2004). worldwide, immunization prevents more than 2.5 million child deaths each year (who/unicef and world bank, 2009, who 2009). global public health has... continue reading ».

50 pages |  717 engagements | 

5. IMPORTANCE OF EXCLUSIVE BREASTFEEDING ON THE HEALTH OF INFANT

» background of the study breast milk is the natural first food for infants (davis, darko & mukuria, 2003). it renders all the nutrients an infant needs for the first six months of life. breastfeeding together with complementary feeding continues to meet a child’s nutritional needs during the second half of the first year until the second year of life when a child could be weaned. it is an... continue reading ».

50 pages |  571 engagements | 

6. NIGHT SHIFT AND IT’S IMPACT UPON THE QUALITY OF LIFE OF NURSES

» chapter one introduction the study is categorized into five chapters. the first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. the chapter two covers the review of literature with emphasis on conceptual framework, theoretical fr... continue reading ».

50 pages |  1,057 engagements | 

7. THE IMPORTANT OF THE FAMILY PLANNING ON WOMEN OF CHILD BEARING AGE (15-49) (A CA...

» abstract this study was carried out to investigate the important of the family planning on women of child bearing age (15 49) using moba local government area, otun ekiti, ekiti state. to achieve this objective, four research questions were stated to guide this study. the data was collected from both primary and secondary sources. the primary data were collected with the help of a well structured ... continue reading ».

80 pages |  1,360 engagements | 

8. PERCEPTION AND PARTICIPATION OF NURSES IN CONTINUING EDUCATION PROGRAMMES

» chapter one introduction 1.1 background of the study the world health organization world health report (who 2010) states that human resources are the most important of the health system’s resource inputs. the performance of health care systems ultimately depends on the knowledge, skills and motivation of the people responsible for delivering services. education and training are key investmen... continue reading ».

50 pages |  1,062 engagements | 

9. EVALUATION OF THE PHYSICO CHEMICAL AN SENSORY PROPERTIES OF INFANT FOOD PRODUCE...

» chapter one introduction 1.1 background to the study infants and young children suffer from malnutrition in most developing countries. the growth of infant in the first and second year of life is very rapid and breast milk alone cannot meet the child’s nutritional requirements. the infant needs supplementary feeding starting from 46 months (achinewhu, 1987; ijarotimi and famurewa, 2006). man... continue reading ».

50 pages |  1,012 engagements | 

10. PERCEPTION AND ATTITUDE OF PREGNANT WOMEN TOWARDS HEPATITIS B INFECTION

» abstract the study was carried out to examine the perception and attitude of pregnant women towards hepatitis b with a particular focus to pregnant women in primary healthcare centre in chanchiga local government area of niger state. to achieve this objective, three research questions were stated to guide this study. the data was collected from primary sources. the primary data were collected with... continue reading ».

50 pages |  1,519 engagements | 

11. FACTORS INFLUENCING VISUAL IMPAIRMENT AND BLINDNESS AMONG THE STUDENTS OF SCHOOL...

» chapter one introduction 1.1 background of the study vision is one of the five (5) senses. being able to see gives us tremendous access to learn about the world around us, people’s faces and difference of expression, what different things look like and how big they are, the physical environment where we live and more including approaching hazards. when vision is impaired, all the aforementio... continue reading ».

50 pages |  1,546 engagements | 

12. ASSESSMENT OF PATIENT ATTITUDE AND PERCEPTION TOWARDS XRAY EXAMINATION

» abstract the use of x rays in medical diagnostic radiology has increased globally. the medical use of x ray for diagnosis of illness is subject to the principles of justification and optimization for the protection of exposed individuals. medical x ray accounts for the largest exposure of humans to man made ionizing radiation. exposure of individuals can lead to long term stochastic effects. over ... continue reading ».

50 pages |  1,152 engagements | 

13. KNOWLEDGE AND PRACTICE OF ADOLESCENTS TOWARDS THE USE OF FAMILY PLANNING METHOD ...

» chapter one introduction 1.1 background of the study teenage sexual activity is a worldwide issue and the age of initiation is rapidly decreasing. the consequences of sexual behavior of teenagers are an enormous burden on themselves and society. these are due mainly to the little or no preparation and guidance they have on how to develop responsible sexual behavior developmentally, adolescents rea... continue reading ».

50 pages |  1,964 engagements | 

14. INCIDENCE OF PROTEIN ENERGY MALNUTRITION AMONG CHILDREN UNDER-FIVE YEARS IN GENE...

» chapter one 1.0 introduction this chapter focuses on the background of the study, statement of problem, objectives of the study, significance of the study, research questions, research hypothesis, scope of the study and operational definition of terms. 1.1 background of the study protein energy malnutrition (pem) refers to a form of malnutrition which is defined as a range of pathological conditio... continue reading ».

50 pages |  1,484 engagements | 

15. KNOWLEDGE AND PRACTICE OF ADOLESCENT ON THE PREVENTION OF SEXUALLY TRANSMITTED I...

» chapter one introduction 1.1 background information sexually transmitted infections (stis) are major health problems affecting young people not only in developing countries but also in developed countries. human immunodeficiency virus (hiv) on the other hand has been receiving a lot of attention worldwide. several studies have reported high rate of prenatal sexual activities among nigeria adolesce... continue reading ».

50 pages |  1,769 engagements | 

16. KNOWLEDGE AND PRACTICE OF MOTHERS ATTENDING CHILD WELFARE CLINIC TOWARDS USE OF ...

» chapter one introduction background of the study diarrhea is the second leading cause of death in children under five years old, and is responsible for deaths of around 760,000 children every year (world health organization, 2013). in addition, low and middle income countries are particularly burdened with this both preventable and treatable condition. targeted interventions includes the provision... continue reading ».

50 pages |  1,433 engagements | 

17. FACTORS AFFECTING SUBSTANCE ABUSE AMONG ADOLESCENTS IN SELECTED SECONDARY SCHOOL...

» chapter one introduction 1.1 background of the study adolescence and puberty can be a very conflicting stage of any child; the environment is of great importance in an adolescent’s personal and social development. during adolescence and young adulthood, young people are presented with opportunities to develop their ideas, attitudes and self image. participation in different kinds of learning... continue reading ».

50 pages |  1,312 engagements | 

18. KNOWLEDGE AND ATTITUDE OF STUDENT NURSES IN SCHOOL OF NURSING, EMEKIKU-OWERRI, I...

» chapter one introduction 1.1 background of the study diarrhoea is one of the most common reasons for one to seek medical advice, it can range from a mild temporary condition to one that can be life threatening. it should not be confused with frequent passing of stools of normal consistency that is not diarrhoea. diarrhoea is characterized by abnormally loose of watery stools more than 3 times in 2... continue reading ».

50 pages |  1,423 engagements | 

19. KNOWLEDGE OF MOTHERS ABOUT FACTORS CONTRIBUTING TO UNDERNUTRITION AMONG 0-5 YEAR...

» chapter one 0 introduction background of the study a mother is the principal provider of the primary care that her child needs during the first six years of its life. the type of care she provides depends to a large extent on her knowledge and understanding of some aspects of basic nutrition and health care. their nutritional knowledge plays an important role on the children health issue. undernut... continue reading ».

50 pages |  1,308 engagements | 

20. QUALITY OF LIFE OF PATIENTS WITH CHRONIC KIDNEY DISEASE IN UNIVERSITY OF ILORIN ...

» chapter one introduction 1.1 background of the study there is an increasing interest in measuring quality of life (qol) in everyday clinical practice. in addition to mortality and morbidity as key indicators for performance, quality of life has been recognized as an important factor for evaluating the quality and outcome of healthcare for patients with chronic illness (macduff, 2015). world health... continue reading ».

50 pages |  708 engagements | 

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Palliative Care Challenges in Nigeria: A qualitative study of interprofessional perceptions

• Medicine, Hospital Medicine Division
• Searle Center for Advancing Learning and Teaching

Research output : Contribution to journal › Article › peer-review

Context: Palliative care awareness, education and practice vary widely across global health systems, especially throughout low- and middle-income countries such as Nigeria. Unfortunately, qualitative investigations into the context, experiences and challenges of Nigerian health care professionals providing palliative care in these settings are still underrepresented in the literature. Objectives: The aim of this study was to better understand the perceptions of palliative care providers in Nigeria. Methods: The authors conducted an online survey of health professionals caring for patients with palliative care and end of life needs. Survey participants were recruited via convenience sampling from a palliative care training program in Lagos, Nigeria. Results: 27 palliative care program participants (12 physicians, seven nurses, four pharmacists, two psychiatrists and two physiotherapists) responded to the two-question survey. 39 free text responses were collected and analyzed. A majority (33%, n = 13) of responses reported challenges associated with caring for patients with cancer. Suboptimal pain management was the second most common response type (18%, n = 7). Other significant responses included caring for patients with comorbidities (13%, n = 5), patients seeking spiritual care (8%, n = 3) and patients who were unable to afford standard treatment (5%, n = 2). Uncategorized responses (23%, n = 9) included experiences caring for patients with injuries sustained in military operations and COVID-19, among others. Conclusion: These results provide valuable insights into the palliative care experiences and challenges of an interdisciplinary set of health care practitioners providing palliative care in Nigeria. Further research is needed to elucidate the facilitators and barriers of delivering palliative care in similar settings.

• Palliative care

ASJC Scopus subject areas

• Clinical Neurology
• Anesthesiology and Pain Medicine
• General Nursing

This output contributes to the following UN Sustainable Development Goals (SDGs)

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• 10.1016/j.jpainsymman.2022.10.002

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• Link to publication in Scopus
• Link to the citations in Scopus

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• patients INIS 100%
• nigeria INIS 100%
• Palliative Therapy Nursing and Health Professions 100%
• surveys INIS 50%
• Patient Nursing and Health Professions 50%
• Health Care Personnel Nursing and Health Professions 20%
• cancer INIS 16%
• education INIS 16%

T1 - Palliative Care Challenges in Nigeria

T2 - A qualitative study of interprofessional perceptions

AU - Doobay-Persaud, Ashti

AU - Solchanyk, Daniel

AU - Fleming, Oriana

AU - Patel, Nikhil

AU - Drane, Denise

AU - Hauser, Joshua

AU - Ogbenna, Ann

N1 - Funding Information: Research reported in this publication was generously supported by the Robert J. Havey, MD Institute for Global Health's philanthropic funds at Northwestern University, Feinberg School of Medicine . All authors declare no conflict of interest. Publisher Copyright: © 2022 The Authors

PY - 2023/1

Y1 - 2023/1

N2 - Context: Palliative care awareness, education and practice vary widely across global health systems, especially throughout low- and middle-income countries such as Nigeria. Unfortunately, qualitative investigations into the context, experiences and challenges of Nigerian health care professionals providing palliative care in these settings are still underrepresented in the literature. Objectives: The aim of this study was to better understand the perceptions of palliative care providers in Nigeria. Methods: The authors conducted an online survey of health professionals caring for patients with palliative care and end of life needs. Survey participants were recruited via convenience sampling from a palliative care training program in Lagos, Nigeria. Results: 27 palliative care program participants (12 physicians, seven nurses, four pharmacists, two psychiatrists and two physiotherapists) responded to the two-question survey. 39 free text responses were collected and analyzed. A majority (33%, n = 13) of responses reported challenges associated with caring for patients with cancer. Suboptimal pain management was the second most common response type (18%, n = 7). Other significant responses included caring for patients with comorbidities (13%, n = 5), patients seeking spiritual care (8%, n = 3) and patients who were unable to afford standard treatment (5%, n = 2). Uncategorized responses (23%, n = 9) included experiences caring for patients with injuries sustained in military operations and COVID-19, among others. Conclusion: These results provide valuable insights into the palliative care experiences and challenges of an interdisciplinary set of health care practitioners providing palliative care in Nigeria. Further research is needed to elucidate the facilitators and barriers of delivering palliative care in similar settings.

AB - Context: Palliative care awareness, education and practice vary widely across global health systems, especially throughout low- and middle-income countries such as Nigeria. Unfortunately, qualitative investigations into the context, experiences and challenges of Nigerian health care professionals providing palliative care in these settings are still underrepresented in the literature. Objectives: The aim of this study was to better understand the perceptions of palliative care providers in Nigeria. Methods: The authors conducted an online survey of health professionals caring for patients with palliative care and end of life needs. Survey participants were recruited via convenience sampling from a palliative care training program in Lagos, Nigeria. Results: 27 palliative care program participants (12 physicians, seven nurses, four pharmacists, two psychiatrists and two physiotherapists) responded to the two-question survey. 39 free text responses were collected and analyzed. A majority (33%, n = 13) of responses reported challenges associated with caring for patients with cancer. Suboptimal pain management was the second most common response type (18%, n = 7). Other significant responses included caring for patients with comorbidities (13%, n = 5), patients seeking spiritual care (8%, n = 3) and patients who were unable to afford standard treatment (5%, n = 2). Uncategorized responses (23%, n = 9) included experiences caring for patients with injuries sustained in military operations and COVID-19, among others. Conclusion: These results provide valuable insights into the palliative care experiences and challenges of an interdisciplinary set of health care practitioners providing palliative care in Nigeria. Further research is needed to elucidate the facilitators and barriers of delivering palliative care in similar settings.

KW - Cancer

KW - Education

KW - Nigeria

KW - Palliative care

KW - Training

UR - http://www.scopus.com/inward/record.url?scp=85141341848&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85141341848&partnerID=8YFLogxK

U2 - 10.1016/j.jpainsymman.2022.10.002

DO - 10.1016/j.jpainsymman.2022.10.002

M3 - Article

C2 - 36244641

AN - SCOPUS:85141341848

SN - 0885-3924

JO - Journal of Pain and Symptom Management

JF - Journal of Pain and Symptom Management

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Nursing Science Project Topics and Materials

Below are Nursing Science Project Topics with available Chapters 1-5. Click on any to preview its Contents

• KNOWLEDGE AND ACCEPTABILITY OF CERVICAL CANCER SCREENING AMONG FEMALE PART-TIME STUDENTS IN UNIVERSITY OF BENIN
• THE PRESENCE OF HEPATITIS B ENVELOPE ANTIBODY IN PATIENTS WHO HAVE BEEN PREVIOUSLY SCREENED FOR THE SURFACE ANTIGEN
• ATTITUDE OF NURSES TOWARDS RELAPSE PREVENTION AMONG PSYCHIATRIC PATIENTS IN FEDERAL NEUROPSYCHIATRIC HOSPITAL BARNAWA, KADUNA
• KNOWLEDGE, ATTITUDE AND PRACTICE OF STANDARD PRECAUTIONS AMONG HEALTH CARE WORKERS
• AN ANALYSIS OF THE INCREASE IN MORTALITY RATE AS A RESULT OF ABORTION AMONG YOUNG WOMEN
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ORIGINAL RESEARCH article

Exploring factors influencing immunization utilization in nigeria—a mixed methods study.

• 1 Global Health Department, Royal Tropical Institute, Amsterdam, Netherlands
• 2 Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
• 3 Ogun State Primary Health Care Development Board, Abeokuta, Nigeria
• 4 Amsterdam Public Health Research Institute, Amsterdam, Netherlands
• 5 Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
• 6 Nursing Department, School of Community Health and Policy, Morgan State University, Baltimore, MD, United States

Background: In 2005, Nigeria adopted the Reach Every Ward strategy to improve vaccination coverage for children, 0–23 months. By 2015, Ogun state had full coverage in 12 of its 20 local government areas but eight had pockets of unimmunized children, with the highest burden (37%) in Remo-North. This study aimed to identify factors in Remo-North influencing the use of immunization services, in order to inform intervention approaches to tackle barriers to immunization utilization.

Methods: We carried out a cross-sectional study using mixed methods including a survey of caregivers of 215 children, 25 semi-structured interviews with stakeholders involved in immunization service delivery and 16 focus group discussions with community men and women ( n = 98). Two wards (Ilara and Ipara) were purposively chosen for the study. Data was analyzed using the SAGE Working Group Vaccine Hesitancy model.

Results: Only 56 children (32.6%) of the 172 children over 9 months of age had immunization cards available for inspection. Of these, 23 (59.6%) were fully immunized, noticeably higher in Ipara than Ilara. However, when immunization status was assessed by card and recall, 84.9% of the children were assessed as fully immunized. Caregivers in the more rural Ilara had less knowledge of vaccine schedules. The importance of all doses was recognized more by Ipara respondents (95.5%) than in Ilara (75.3%) ( p < 0.05). Community links to immunization and household decision-making patterns influenced immunization use in both wards. Migrants and those living in hard-to-reach areas were disadvantaged in both wards. Health service factors like absence of delivery services, shortage of health workers, unavailability of vaccines at scheduled times, and indirect costs of immunization contributed to low utilization.

Conclusion: Immunization utilization was influenced by interlinked community and health services issues. Intervention approaches should ensure that communities' priorities are addressed, actors at both levels involved and strategies are adjusted to suit contexts.

Introduction

Immunization is considered one of the most cost-effective health interventions, reducing under-five mortality ( 1 ). Global immunization coverage from 2010 to 2015 shows that at least 85% of children received three doses of diphtheria-pertussis-tetanus (DPT) vaccine ( 2 ). However, in 2015, the number of children without routine immunization (RI) was 19.4 million globally ( 2 ). The majority (75%) of non-immunized children live in 10 countries, including Nigeria ( 1 ).

Nigeria is the most densely populated country in Africa with an annual population growth rate of 2.83% ( 3 ) and is the second largest contributor to under–five mortality in the world ( 4 ). According to the 2013 National Demographic Health Survey (NDHS) ( 5 ), only 25% of children aged 12–23 months completed the prescribed course of RI. However, there are marked inequalities across geopolitical zones with immunization completion ranging from about 50% in the South-West and South-South to 27, 14, and 10% in the North-Central, North-East and North-West, respectively. Factors responsible for this poor performance ( 6 , 7 ) include medical mistrust driven by socio-political factors ( 8 , 9 ), weak health systems with poor patronage by clients, hostile attitudes of health workers, conflicts between competing programmes and between routine and supplemental immunization activities ( 10 ). Vaccines are usually procured by the Federal government with the support of donor organizations such as the Global Alliance for Vaccines and Immunization (GAVI). However, though these vaccines are supplied free to the states' primary health care development agencies, indirect costs of immunization due to logistics and illegal charges by health workers at the health facility level, limit vaccine availability to users ( 11 ).

Reaching Every Ward (REW), an approach developed in 2002 by the World Health Organization (WHO) and partners, provides a framework for strengthening national immunization programmes ( 12 ). In order to improve immunization coverage, Nigeria adopted the REW strategy in 2005. The REW strategy focuses on RI in health facilities and outreaches, including components such as improved access for under-served and hard-to-reach areas; support supervision; monitoring and use of data for action; community mobilization and improving community links with service delivery. These community linkages include the Ward Development Committee (WDC)-linked to primary health care including immunization at ward level; and the Social Mobilization Committee (SMC), focused specifically on immunization at local government level. The RI schedule is detailed in Box 1 .

Box 1 . Routine immunization schedule.

At Birth—BCG; OPV; HBV

6 Weeks—OPV; PENT A; PCV

10 Weeks—OPV; PENTA; PCV

14 Weeks—OPV; PENTA; PCV; IPV

9 Months—Yellow Fever Vaccine, Measles Vaccine and Vitamin A

BCG—Bacillus Calmette-Guérin

OPV—Oral Polio Vaccine

HBV—Hepatitis B Vaccine

PENTA—Pentavalent Vaccine against Haemophilus influenzae type B ,

Diphtheria, Pertussis, Tetanus and Hepatitis B

PCV—Pneumococcal Conjugate vaccine

IPV—Inactivated polio vaccine

Since 2009, Ogun state in South-West Nigeria has recorded consistent increase in RI coverage in all its twenty Local Government Areas (LGAs) with coverage as high as 107% 1 . However, in 2015, there were still pockets of unimmunized children in eight LGAs, with a total of about 9,394 (16%) children unimmunized, and the highest proportion in Remo-North LGA (37%). The factors responsible for this trend in the eight LGAs were unknown.

This study aimed to identify factors influencing the use of immunization services in Remo-North, in order to inform intervention approaches to tackle barriers to immunization utilization.

We carried out a cross-sectional study using mixed methods, comprising a household survey, focus group discussions and semi-structured interviews. We used the qualitative interviews to explain the results of the survey and to gain more insight into contextual factors. We used a convergent (concurrent) mixed methods design-the quantitative and qualitative data were collected in parallel, within the same time frame. Integration was carried out during data analysis and interpretation of results. Quantitative data provided a starting point for analysis, and qualitative data were then used to further explain the quantitative results. If areas of divergence emerged, we ascertained the cause of the disparity before drawing conclusions. For instance, we checked if the difference was caused by answers given by stakeholders due to hierarchy or social desirability; or due to researcher error such as framing of questions; or due to incorrect interpretation of results.

Household survey of caregivers responsible for the vaccination of at least one under-five child was conducted. Close-ended questionnaires were administered. Variables such as knowledge and utilization of immunization facilities, community links, and child's immunization details were collected. The primary study outcome was immunization completeness—assessed as three doses of Diphtheria, Pertussis, Tetanus (DPT)/Pentavalent vaccine as well as measles and yellow fever recorded as administered in an immunization card. The primary exposure variables were location, respondent's educational status, family wealth status, respondent's literacy, and employment status. Respondents were categorized as having no formal or only preschool education; or having primary, secondary or tertiary education. Respondent literacy was assessed by having them read a simple sentence “Remo North is a great place to live in.” Family wealth was assessed using standard wealth items of living condition, household amenities, and ownership of household assets from the National Demographic and Health Survey. Employment status responses were summarized as currently employed or unemployed.

Focus Group Discussions (FGDs) took place with community members. Participants were separated according to gender and age—women of child-bearing age and older women (above 40 years); young men and older men. FGDs provided insight into the expectations and needs of the communities regarding immunization, their perceptions of health and immunization services and existing community linkages to immunization service delivery.

Semi-structured interviews (SSIs) were carried out with frontline health workers, policy makers, local government implementers, religious and traditional leaders and community stakeholders in social mobilization structures (such as WDC and SMC) linked to immunization service delivery. These SSIs were used to gain insight into facilitators and barriers to improving immunization coverage; challenges in the implementation of immunization services; community collaborations for immunization service delivery; and stakeholders' perceptions of how immunization service delivery is matched to community needs.

Data collection was carried out in May 2016 by a team of two quantitative and two qualitative researchers and three research assistants. The researchers consisted of two men and two women—all with medical backgrounds. Three of them were academics. One male researcher was a policy maker from Ogun state and was not directly involved in the data analysis so as to reduce bias but he provided insight during interpretation of data. The two qualitative researchers were women. Fieldwork commenced with training and piloting of tools. Two trained research assistants functioned as coordinators in each ward, respectively, and a third coordinated all administrative and logistic processes.

Research Setting

Remo-North LGA was purposively chosen for the study because it had the highest burden of unimmunized children in Ogun State. Ipara and Ilara, the best and worst performing wards were also purposively selected. For this study, we chose two focal wards from Remo-North LGA using the criteria of performance—determined by immunization coverage trends in the National Health Management Information System (NHMIS). Ipara and Ilara were the best and worst performing wards in Remo-North, respectively. We wanted to find out whether there were differences in the sites which could explain the outcome (immunization coverage). In 2015, immunization coverage in Ilara was remarkably low—with only 26% of children (compared to 78% in 2014) fully immunized. Ipara ward performed much better with 76% of children (compared to 69% in 2014) fully immunized, lagging slightly behind the National Programme on Immunization's acceptable minimum of 80%. From 2014 to 2015, immunization coverage improved across all the antigens in Ipara while in Ilara, coverage dropped precipitously across all antigens.

Both wards had similar socio-cultural contexts however there were a few differences. Ilara is located on the outskirts of Remo-North and is a farm settlement; it is more remote and rural than Ipara. Furthermore, the access road is bad, limiting commercial activities. Ipara is perceived to have more educated people than Ilara, is described as a “semi-rural” ward and has a more organized structure with numbered streets. The communal lifestyle of the Ilara people enables easy access to their king (Kabiyesi)—the prime traditional ruler of the ward. The “kings” are powerful figures in the wards and exert strong influence over the political, socio-cultural, and economic structures within their areas of jurisdiction. In Ipara, community members are relatively less dependent on their king though traditional protocols are observed.

Sampling and Recruitment

The population of Ilara was 6,512 compared to 9,100 of Ipara (2017). The Yoruba tribal group are indigenous in the state and make up the majority of the population in both wards. According to the Ogun State Primary Health Care Development Board (SPHCDB), Department of Research and Statistics (2019), Non-indigenous groups make up about 10% (600 and 974 people in Ilara and Ipara, respectively) of the population. Non-indigenous groups in the wards are migrants from other states in the country (examples include the Eguns, Igedes, and Ohoris); as well as migrants from the neighboring Benin Republic—this group are popularly referred to as “the Cotonous.”

Ipara and Ilara had estimated under-5 populations of 1,820 and 1,302, respectively (SPHCDA 2017). We sampled 210 adults representing 215 under-5 children, using the WHO modified two-stage cluster sampling method ( 13 ), with a 100% response rate in selected households. A total of 30 clusters were selected from both wards according to their relative populations. To estimate the difference between the proportion of unimmunized children- estimated at 23% (based on NHMIS data) and an endline estimate of 10% (alpha of 5% and power of 80%) would have required a sample size of 127 children. However, we aimed to study a minimum of 210 children (at least 7 children from each of 30 clusters) across the two selected wards. Individuals were eligible as survey respondents if they were caregivers of children under-5 and were currently domiciled in the ward. We aimed to exclude individuals with speech and perceptual challenges based on inability to communicate or respondents showing difficulty with understanding date, period of the year or purpose of the interaction/study but none of such individuals were encountered during the study.

For the FGDs, purposive sampling was employed. A total of 16 FGDs were held with community men and women in the two wards. Adults who were caregivers or involved in the immunization decision-making relating to a child (or grandchild) were included in the discussions. Research assistants recruited participants with the help of community mobilizers. To ensure the free participation of men and women, participants were separated according to gender and age—young women of child bearing age and older women; young men and older men. Investigators ensured a blend of socio-economic groups during the sampling of participants and the FGDs were conducted until saturation of information was achieved.

A total of 25 stakeholders involved in immunization service delivery were recruited for SSIs using purposive sampling and in some cases snowball sampling. They included policy makers, local government implementers, health workers, and community (committee) leaders. We aimed for diversity and interviewed different stakeholders in the various categories. We continued interviewing until no new information emerged and saturation was reached.

Data Analysis

We adapted the WHO Strategic Advisory Group of Experts (SAGE) Vaccine Hesitancy model ( 14 ) which mapped the determinants of vaccine hesitancy based on systematic review of literature and interviews with immunization managers of state and national levels immunization programmes in 13 countries (see Figure 1 ). The model is based on the premise that attitudes to vaccination is a continuum ranging from complete acceptance to total refusal. Vaccine hesitancy is defined as a locus within this continuum and could result in acceptance of some vaccines and refusal of others, delayed vaccination and tentative acceptance, thereby influencing overall immunization utilization. The model differentiates between contextual, individual, group, and vaccine/vaccination-specific factors that influence immunization acceptance and utilization. The causes of vaccine hesitancy were found to be context-specific and Dube et al. ( 14 ) noted the need to identify locally relevant factors in order to develop appropriate strategies to tackle them.

Figure 1 . Conceptual framework.

Recognizing that the health sector, including immunization services, is a complex adaptive system, and different elements within the context are interlinked, and influence how immunization services function, we took a systems perspective: since the REW strategic components have community participation elements, we also explored the policies on community participation and action. We used the SAGE model in our analysis to group the determinants of vaccine hesitancy and immunization use in both contexts; and to gain more insight into contextual and other influences.

The conceptual framework is presented in Figure 1 .

This study was the baseline for a participatory action research on immunization. An aim of the quantitative component was to derive a measure of immunization uptake pre-intervention which would be supported by NHMIS data.

Primary quantitative data was entered into Statistical Package for the Social Sciences version 21 2 by trained data clerks. A wealth index was derived using productive and non-productive household assets, household amenities and other measures of household living standard. Immunization was assessed as complete if an immunization card was seen and three doses of DPT/Pentavalent vaccine as well as measles and yellow fever had been recorded as administered. A secondary measure of immunization completeness was derived and reported as present for individuals satisfying the primary outcome or reporting ownership of an immunization card (which could not be provided for inspection) and reporting the child had received DPT/Pentavalent, measles and yellow fever vaccines. Descriptive statistics were calculated for variables using a survey design adjusted logistic generalized linear model. As the sample framework used a proportion to population sample to assign clusters within wards and to select clusters within wards, the total sample was considered to be self-weighing at the ward level. Therefore, weighing of individual observations proportional to their respective sampling fractions were not applied.

A multivariate logistic regression was performed for children above the age of 9 months to identify factors associated with completion of immunization. Ward, age and gender of child, employment status and highest level of education of caregiver, and wealth quintile of the household were taken into account in this analysis to adjust for confounding and possible association between these individual factors. Ninety-five percent Confidence Intervals (CIs), lower and upper CIs (LCI and UCI), Odds Ratios (OR), Standard Errors (SE), and p -values (p) of the factors included in the model are presented in Table 4 . Please take note that cautious interpretation of this data is advised as the sample size is relatively small. We therefore limited the number of factors included. A general rule of thumb is that, per factor included, at least 10 cases for every category of the factor should exist.

FGD and SSIs were audio-taped and transcribed. Data was analyzed using the qualitative data analysis software, NVivo 11 3 . An inductive approach and open thematic coding were used. Transcripts were read and coded by two qualitative researchers, using common themes and sub-themes according to the conceptual framework. A third qualitative researcher coded a few transcripts to ratify the codes and themes/sub-themes identified. Analysis was conducted iteratively using a three-pronged approach: “noticing, collecting, and thinking” ( 15 ). We aimed to understand immunization utilization in both wards; if there were vulnerable groups; and whether there were differences in opinions and experiences between specific groups and between the two wards.

Triangulation of data was carried out using quantitative and different qualitative methods to ask the same questions, and asking different types of respondents the same questions. This enabled us to identify areas of agreement and disagreement between and within groups of respondents. We compared and contrasted answers between different respondent groups and between the two wards. We assigned weights in the qualitative analysis using the frequency of respondents' perceptions and agreements between different interviews and respondents.

After the description of respondents, the relevant influencing factors are presented according to the conceptual framework. Where applicable, the survey results are presented before the qualitative findings.

Background and Respondents' Characteristics

Out of the 210 households surveyed, 124 households (59%) were studied in Ipara- the more populated of the two wards. All the 210 respondents were female caregivers. Most were Yoruba (89%)—this was a reflection of the general population ratio between indigenous people and migrants. Over 90% reported that they had attended school in some form (pre-school, primary, secondary, or higher education). Nevertheless, 32% of the respondents were unable to read the basic sentence provided and were therefore considered functionally illiterate (details in Table 1 ).

Table 1 . HHS—respondents' background and characteristics.

A total of 16 FGD (8 in each ward) were carried out. There were 6–7 respondents in each FGD ( N = 98) and the characteristics of the respondents are summarized in Table 2 .

Table 2 . Characteristics of FGD respondents.

We interviewed a total of 15 policy makers, local government implementers, and frontline health workers. Their specific functions are displayed in Table 3 . Ten community stakeholders were also interviewed—they consisted of religious leaders and the foremost traditional rulers in both wards; and (post-holding) members of three different community mobilization structures. The WDC was not functioning in Ilara, and members of the Community Development Association (CDA)—set up by the community to address general development issues including health—were interviewed instead. Table 3 gives details of the community stakeholders.

Table 3 . SSI respondents at state, local government, and ward levels.

Immunization Utilization in Ipara and Ilara Wards

The mean age and range of the children whose caregivers responded to this study was 24.4 ± 15.7 months, and more than half of them were male. The RI schedule in Nigeria administers the final antigens (measles and yellow fever vaccines) at 9 months of age. The analysis of immunization completeness encompasses all children older than 9 months who should have plausibly achieved this outcome. Only 56 children (32.6%) of the 172 children over 9 months of age had immunization cards available for inspection. 23 (59.6%) of these children were fully immunized, noticeably higher at 67.6% in Ipara when compared to 47.8% in Ilara. However, when immunization status was assessed by card and recall 146 (84.9%) of the 172 children were reported as fully immunized, with 88.1% in Ipara and 79.3% in Ilara ( p < 0.05). The utilization figures reported by recall were most likely not reliable—caregivers cannot be expected to recall number of immunization doses with precision and this figure may approximate immunization commencement rather than completion.

Factors Influencing Immunization Use

Contextual influences.

Contextual influences on immunization utilization explored related to the socio-economic factors, religion, culture, gender, geographic barriers, politics, and policies.

Socio-economic/religion/culture/gender

The reasons given for the levels of utilization of immunization services in the communities included ethnicity, culture, household decision making, and gender relations. There was no major difference in the survey and in the qualitative interviews regarding utilization of immunization between the three main religious groups (Christian, Muslim, and Traditional) or between people of different socio-economic status in both wards. In the survey, though caregivers from households in the 3rd or 4th quintiles were more likely to fully immunize their children compared to those in the other quintiles, this was not statistically significant (see Table 4 ).

Table 4 . Multivariate logistic regression.

Culture and Ethnicity played important roles in both Ipara and Ilara. Some cultural factors were illuminated when FGD respondents were asked about which seasons and events made it difficult for them to bring their children for RI. Several traditional festivals were described as events where the women were unable to come due to traditional rituals and imposed curfews. However, the perspectives of women and men differed. The women specified the months from September to December as months that were particularly difficult because of these festivals and events.

“ Oro festival always impedes the immunization exercise because women cannot go out.” (Young woman, Ipara)

However, this notion was dismissed by the older men who stated that the women were busy for other reasons.

“ What we noticed is that those mothers, once it is the period of washing kola nut or going to the market, they may see spending one hour at the maternity as not being convenient. But all these usually happen between September and December - the period of washing kola nut - that period they are always very busy; but I think spending just one hour on their child in a month should not be too difficult a task.” (Older man, Ipara)

The indigenous Yorubas were perceived by the health workers, policy makers and FGD respondents as utilizing immunization the most compared with migrant groups. Poor utilization by migrants was perceived as mainly due to their cultural beliefs especially those that valued traditional above western remedies. Additionally, the Cotonous were reported to refuse immunization for their children mainly for reasons associated with lack of trust in the quality of the health services which they considered as inferior to the health services in Benin Republic. Low utilization by this group was said to be further compounded by their preference for home deliveries, language barriers and their occupation (farming)- which made them unavailable for scheduled immunization activities. Nevertheless, among all the groups, the Igedes were frequently mentioned as the most resistant to the immunization of their young children. Some FGD participants in Ilara described them as being intractable in their stance even in the face of threats by the Kabiyesi (king) to eject them from the communities.

“ Some of them (the Igedes) are very stubborn, they won't take the vaccine, no matter what.” (Young woman, Ilara)

Household decision making dynamics illuminated the gender relations/roles . The majority of caregivers (all females) in the HHS (88.6%) reported that they were the ones who made the decision to immunize their children. Additionally, 60% of the respondents named themselves as the primary influencer (67.7% in Ipara, statistically significantly more than the 46.7% in Ilara) while 19% named their spouses as influencers. These answers were remarkably different from those from the FGDs. In the FGDs, the women reported playing strong roles in affecting/-and effecting decisions on immunization of their children but the men were the primary decision makers on immunization issues. However, respondents reported numerous influences outside the nuclear family that directed immunization utilization decisions: the men were strongly influenced by their mothers, while the women valued the direction of their fathers/fathers-in-law who also happened to be the elders in the communities. The summary of the effect of this gender interplay is that even if women wanted to immunize their children, they could not do so if their husbands did not agree; or if their husbands' mothers refused. Additionally, the young women listened to the elders which affected their decisions to immunize their children.

Geographic barriers

Eighty-one percent of respondents in the survey regarded the distance to immunization facilities as “short or very short.” This was similar to findings in the FGDs where health facilities were reported as being generally within walking distance to many households in both wards. However, a disadvantaged group mentioned especially in the SSIs were people living in “hard-to-reach” areas like Aba James and Ifote, which had difficult terrains and were usually inaccessible during the rainy season.

Local government officials and health workers described low utilization of RI at health facilities in both wards (more in Ilara than Ipara) adding that gains so far recorded in the programme were partly due to outreach activities. However, they noted that geographically disadvantaged areas did not benefit much from outreaches due to financial limitations in the programme.

Policies and politics

According to the policy makers and local government officials, there are national and local policies supporting community participation and action in immunization. Immunization is a priority issue in the country, supported by GAVI and other multilateral organizations. There are clear policies related to the immunization programme and structures in place for implementation of the strategies and plans linked to policy. They noted that successful adoption and implementation within the local contexts were reliant on cooperation from the community leaders and community members—with monitoring being key.

The SMC are responsible for immunization campaigns and community mobilization as well as conflict resolution relating to immunization issues in the wards. The WDC acts as partners providing a gateway to the communities and support in community mobilization and outreaches.

Respondents in the survey (58 and 34%, respectively) named the SMC and WDC as the main community structures linked to immunization and important sources of information regarding immunization. In the FGDs, the young women (especially in Ilara) reported being unaware of any committee responsible for immunization or health in the community. The older men and women however described the community committees but those in Ilara noted that the WDC had been defunct in the ward since 2014 due to excessive politicization of the committee which led to the loss of interest of the traditional ruler. According to the respondents, before it became defunct, the WDC used to have monthly meetings with the king and the health workers in the primary health center. The Ilara CDA had therefore been in charge of immunization issues since 2014 but was described in the FGDs as “functioning poorly.” The CDA was described by both the older men and women as being politically motivated, with posts in the committee assigned by the local government in power.

The Ipara WDC was also described as being politically motivated but rated as functioning well by the older men and women groups; and more cautiously by the young women:

“ Well, what I can say is that, they try their best but you know our people, nobody wants to do things for free.” (Young woman, Ipara)

When asked about their perception of their wards, the majority of the respondents in the FGDs in Ilara stated that Ilara was marginalized within the LGA. This was in contrast to their Ipara counterparts, most of whom were of the view that Ipara was a progressive ward.

Individual and Group Influences

The main factors related to individual and group influences were knowledge and awareness of the value of immunization, beliefs and attitudes toward immunization, past experiences with immunization and health services factors which influenced trust and personal experiences of caregivers and household decision-makers.

Knowledge and awareness

The only statistically significant factor (note low cell frequencies in some instances) of complete immunization status for children above 9 months was the completion of higher education by the mother ( OR = 1.47, p < 0.0001) (see Table 4 ).

The study showed evidence of awareness and knowledge of the value of immunization in both wards—more in Ipara than Ilara—with reported need for more awareness raising and knowledge improvement in several areas like the need for completion of immunization and understanding of vaccine schedules. In the survey, majority (95.7%) of the respondents (99.2 and 89.6% in Ipara and Ilara, respectively, p > 0.05) stated that immunization prevents diseases, with polio and measles being the vaccine preventable diseases that they were most aware of. However, only 37.7% of respondents [Ipara (45.9%) and Ilara (23.4%), p > 0.05] knew when the dosages of the different immunizations should be given. The importance of all doses was recognized by 88.1% of respondents, more so in Ipara (95.5%) than in Ilara (75.3%)—statistically significant at a 5% level of significance determined by non-overlapping 95% CI.

The findings in the FGDs and SSIs confirmed that there was a “good” level of awareness and knowledge about immunization and its value. However, most policy makers and local government officials responded that there was a need to improve awareness and knowledge for all the groups. Some described an issue whereby some care givers would think their children had completed vaccinations by taking only one vaccination. Traditional and religious leaders in both wards noted that awareness and knowledge were hampered by insufficient health education:

“ All tribes and religions support it (immunization) because no one wants to die. It is because the publicity of this program is not enough in our community that causes the low turnout.” (Community leader, Ipara)

There were differences between the key sources of information relating to immunization and caregivers (mostly mothers)' information-seeking behavior. Health workers were reported in the survey (85.2%) as the most important (and commonest) source of information about immunization. This finding was supported by the FGDs. In Ipara, statistically significantly more respondents (92.5%) than in Ilara (72.7%) indicated health workers as the commonest source. However, according to the FGDs, young women appeared to resort first to the elders (older men) in the communities for answers to their immunization questions or to the members of the WDC and CDA, who then would point them to the health workers. This finding was interesting since many of the young women could not mention the names of the WDC/CDA members. It is possible that the young women valued the opinion of the elders because of their standing within the family structure rather than because of their roles in the community structures.

Beliefs/attitudes

Common beliefs in the communities about immunization which were mentioned by the caregivers in the FGDs include beliefs that immunization: kills children; was the “white man's” way of achieving family planning and population control; causes deformities in children especially when given to the pregnant mother; and could actually cause paralysis in children. Many respondents (especially the older women and men) in the FGDs said that they did not believe this anymore having seen the benefits of immunization. However, some of them expressed that the traditional ways could not be discounted completely, that the elders knew how to treat certain diseases like measles better than the protection offered by the vaccines. Indeed, the issue of measles came up frequently in the interviews as an area of tension between orthodox and traditional medicine. In both Ilara and Ipara, vaccine hesitancy was most frequently reported for measles vaccine compared to the other vaccines on the immunization schedule.

Health services factors

Key health services issues mentioned by respondents include the absence of antenatal and delivery services in Ilara; lack of well-equipped and functioning health facilities; and shortage of health workers.

The presence of antenatal and delivery services in the health centers played a key role in driving immunization utilization. This was seen clearly in Ilara where FGD respondents reported that the absence of delivery facilities discouraged women of all tribal groups from using immunization services at the facility. In Ipara, delivery services at the health facility promoted the use of health and immunization services. Young mothers in Ilara expressed the need for a health center where they could have antenatal services but noted that the current health center needed to be more functional to meet those expectations. Young mothers in Ipara were happy with delivery services in the health center but wanted the facility to be upgraded to also take deliveries for primigravid women so as to improve immunization use by that group of stakeholders. However, young women in the FGDs in both wards stated that the immunization outreach services in markets, schools, churches and mosques were very useful in ensuring that people that would not come to the health centers to get their children vaccinated were reached.

Community members' perceptions about conditions of the health facilities , were mostly unfavorable especially in terms of the environment, poor/inadequate infrastructure and lack of equipment and supplies, more so in Ilara than Ipara. According to the FGDs, this resulted in a reluctance of the community members to access care in their health facilities further reducing RI utilization. This was supported by the survey-−55% of the respondents reported that the last immunization taken for their child(ren) was from the fixed government health facility while 34% reported outreaches as their source.

“ If you don't have money, you can explain to the health worker politely and they will understand, but if you say it in an aggressive way like saying, ‘we learnt it is free why are you collecting money?' it is not good. Although they will still give the immunization because it is free, after they have given immunization, they will request for a token.” (Young woman, Ipara)

Regarding the availability of health workers to carry out immunization, the respondent groups were unanimous in their answers that there was a shortage of health workers and described that as an important issue linked to the availability of vaccines.

Experience with past immunization

There was consensus in the FGDs in both wards that Adverse Events Following Immunization (AEFI) were the greatest demotivating factor against completion of immunization. AEFI also promoted fear among young mothers and fathers, thereby deterring initial use of immunization. It was also the reason for reported loss of confidence by the community members (especially young men in both wards) in the quality of vaccines; and loss of trust in the competence of the health workers. Additionally, the distress caused by the excessive crying of the children due to fever and swollen limbs was reported as the reason why some of the young men instructed their wives to discontinue immunization of their children.

“ What I also think is that, sometimes the swollen arm might not be caused by the vaccine but by the person who administered it. He might be too hard in injecting the patient or giving it in the wrong place. It has happened to the people we know; it has even happened particularly to my wife. Her arm was swollen” [Another respondent interrupts] “When my baby took the injection, his arm was swollen and he was weak and I was wondering if this will encourage immunization, these things caused me to become skeptical about immunization.” (Young men, Ipara)

Nonetheless, many of the community stakeholders in the SSIs in both wards were of the opinion that overall immunization was generally well-utilized and that this was evidenced by the reduction in childhood diseases and mortality.

Vaccination Services Specific Influences

Key findings in this section relate to reliability of vaccine supply; costs; and role of health care professionals.

Reliability of vaccine supply

Unavailability of vaccines at the scheduled times was the most frequent complaint by the FGD respondents in both wards. Young mothers in both wards expected that in addition to decreased waiting times, vaccines should be regularly available in health facilities and administered according to the immunization programme schedule. Logistical challenges resulting in vaccines being largely unavailable on schedule for routine immunization were acknowledged by the health workers and policy makers though many emphasized the availability of vaccines at the local government level. One major reason given for the problem was the need to transport vaccines from the cold store in the local government headquarters (Isara) on RI days. Furthermore, recipients had to reach a critical mass (estimated range from 9 to 20 children) before some vaccine vials could be opened for use. Inadequate electrical power supply further challenged the vaccine cold chain and thwarted the possibility to store vaccines at facilities.

Sixty percent of the survey respondents reported that there was no direct or indirect cost for immunization; 29% considered the cost of the service as cheap and 4% thought it was expensive. Unavailability of vaccines at the scheduled times in the health facilities contributed to indirect costs of immunization. To overcome the logistical challenges, respondents described contributing money for the transportation of the vaccines. There was consensus among the FGDs participants that the money paid for the transportation of the vaccines was not really the problem—they were more concerned about the availability of the vaccines according to the schedule, which did not seem to be assured regardless of payments made. Nonetheless, many of the FGD respondents complained about the money used to pay for immunization cards, exercise books, pens and occasionally syringes and needles. Additionally, in Ipara, some of the young women referred to giving “tokens” to health workers.

“ If you don't have money, you can explain to the health worker politely and they will understand, but if you say it in an aggressive way like saying, “we learnt it is free why are you collecting money?” it is not good. Although they will still give the immunization because it is free, after they have given immunization, they will request for a token. (Young women, Ipara)

Role of health care professionals

Though in the survey, 89% of respondents reported health workers' behavior as “helpful” or “very helpful,” responsiveness of the health workers in relation to vaccination services was considered unsatisfactory by the FGD respondents from both wards. The FGDs provided a platform for more detailed assessment of health worker behavior: respondents complained about health workers not sending reminders on time about RI or outreach days, and blamed them for AEFI such as swollen injection sites. Complaints of unavailability of vaccines according to schedule and the resultant long waiting times were attributed to health workers' ineffectiveness.

However, health workers, local government officials and policy makers rated the current immunization programme as responsive to the needs of the communities in Remo North LGA—with trained and capable health workers, though seriously short-staffed. All reported widespread staffing shortage for immunization activities resulting in heavy workload for available staff, further exacerbated by additional assignments from other programmes.

“ …The Community Health Extension Worker on duty at a time, will be the one to vaccinate the children, and also attend to patients, the work load is much for us…” (Health worker)

Remo North was highlighted as the LGA with the highest number of unimmunized children in Ogun state. Though the majority of caregivers in the survey reported that they had completely immunized their children, this could not be validated as the vaccination cards for many of the children were not available to be assessed. Estimation of immunization coverage by maternal recall, though an accepted practice in developing and developed countries ( 16 , 17 ), is fraught with the likelihood of recall bias. The assessment by cards only, highlighted low immunization coverage (59.6%)—this is likely a more reliable picture despite the small sample size. Similar low immunization coverage has been seen in other studies in Nigeria ( 5 , 18 – 20 ).

The study identified many determinants of immunization use. However, it is important to identify the key drivers in order to design credible and realistic interventions.

Contextual factors driving immunization utilization in both wards were mostly alike but there were a few important differences. The socio-economic/cultural and gender factors elicited in this study showed different structures in the wards which promoted inequalities in immunization use. Cultural beliefs (such as traditional methods being better for dealing with childhood diseases especially measles); rumors; and the politicization of community links to immunization delivery clearly (negatively) affected immunization utilization in this study—more in Ilara than in Ipara. The migrants in both wards also did not utilize immunization well. However, the frequency with which this was mentioned by all groups of stakeholders may also be due to some level of ethnic-based bias. It is to be noted that these groups were a minority (consisting only about a tenth of the population) and therefore could not account for the magnitude of the issues especially the low coverage in Ilara which clearly also suggests non-utilization by indigenous people. Involving traditional leaders in the communities in the immunization programme was seen as important in this study due to their level of influence. Nevertheless, this has not tackled the problem of poor utilization of immunization by indigenes and migrants in both wards. Nonetheless, immunization coverage in Ilara declined precipitously from 2014 to 2015 coinciding with the demise of the WDC in 2014 and this overlap in timing suggests that the WDC backed by the foremost traditional ruler was a major driver of immunization in that ward. Though not much is documented in Nigeria, this finding is supported by Sagar et al. ( 21 ) who noted that in India dropouts resulted from poor community linkages.

Many of the contextual factors identified in this study cannot be easily addressed since they are entrenched in the cultural and political strata and may be outside the influence of the health sector. However, the social mobilization structures (WDC and SMC) are already embedded in the design of the vaccination programme and strategies can be developed to strengthen these (and minimize political interferences), in order to drive the social and behavioral change needed to overcome vaccine hesitancy and improve immunization utilization.

Though the study showed that young women in Ilara and Ipara were knowledgeable and aware of immunization and its value, the poor knowledge of vaccine schedules and times for the doses displayed by Ilara young women gave a hint as to why their understanding of the value of immunization had not translated to more utilization. Gender patterns in decision making and the more generalized dissatisfaction expressed in Ilara household and community networks of influence regarding their health services may also account for this. However, the gender differences displayed in the perceptions relating to barriers to access that women experienced during festivals suggests that there may be a need to increase awareness among males in order to tackle this hindrance.

There were contradictions in the views of young women in the survey and all the stakeholders in the qualitative interviews regarding who was the primary influence in immunization at household level. Policy makers, health workers and many community members in the IDIs and FGDs were of the view that the final decision is with the husbands. It is possible that this question was not asked in a way that was understood by the respondents in the survey. Some of the caregivers may have regarded the fact that they were the ones who took the children to the health center for immunization as equating to primary decision making.

Health service factors were key drivers of immunization utilization in this study. Health workforce shortage was a frequently mentioned problem which hindered immunization service delivery in both wards—though to a lesser extent in the semi-rural Ipara which is more likely to attract and retain health workers than Ilara. Health facility (institutional) births also improved the likelihood of immunization utilization in Ipara where antenatal care services in the health center provided a portal for health/immunization education and awareness. Similar studies in Nigeria ( 22 , 23 ), Ethiopia ( 24 ), and other contexts ( 21 , 25 ) have documented that health facility births positively influence immunization use and completion.

AEFI was perceived by the respondents as the major cause of loss of confidence in the competence of the health workers and the quality of the vaccines in both wards. This issue of loss of trust in immunization services has important consequences and has led to the boycott of polio vaccination in some parts of Nigeria in the past ( 9 , 26 ). The fear of AEFI contibuted to vaccine hesitancy, low utilization of immunization and dropouts in both Ilara and Ipara—a finding supported by studies in Nigeria ( 27 , 28 ) and other contexts ( 29 ).

An important supply-side limitation common to both wards was the irregularities associated with the availability of vaccines for RI in the health facilities—a common finding in other Nigerian studies ( 22 , 23 , 27 ), and usually as a result of logistical problems rather than stock out. Unavailability of immunization cards was also an important problem and has been documented extensively ( 24 , 28 , 30 – 32 ), with many studies showing that availability of immunization cards improves the likelihood of children getting immunized. Evidence clearly shows that when immunization cards are readily available and proper information recorded in them, this enhances continued use of immunization by community members ( 28 , 33 , 34 ). Additionally, this would improve validity and enable savings from not revaccinating children needlessly ( 35 ).

Overall vaccine hesitancy was exhibited more in Ilara than Ipara. The SAGE model has helped us to group the determinants of vaccine hesitancy and immunization use in both contexts better. However, because health (and immunization) services is a complex adaptive system, it is difficult to fit everything into the three linear boxes in the framework as the factors are interlinked. For instance, trust and personal experiences with immunization are influenced by both health and vaccination services factors and can also be affected by considerations that are culturally driven.

Furthermore, though Ilara and Ipara are both in the same LGA, their (different) contexts play critical roles in the success (or failure) of the vaccination programme. This displays a need for locally context-specific strategies and approaches to addressing the issues related to vaccine hesitancy and immunization utilization.

Low immunization coverage (26%) in Ilara points to a need for critical, swift and practical solutions—key among which is the improvement of awareness and knowledge of the vaccination schedule. Improving the condition of the Ilara health facility and provision of antenatal and delivery services to the young women would encourage the utilization of health (and immunization) services. Reviving the WDC in Ilara is also important to ensure effective community mobilization and drive demand for services.

There is an urgent need to strengthen capacity for vaccine pharmacovigilance in both Ilara and Ipara in order to recognize and respond speedily to adverse events. Likewise, it is necessary to address reasons associated with dropouts; and an important place to start would be to ensure that vaccines are available at scheduled times without costs to the users. Also, though their proportion is small, it may be useful to tackle poor utilization by migrants in order to achieve full immunization coverage.

Limitations of the Study

Due to the need to understand perspectives on immunization among mothers of under-5 children broadly, we did not limit the immunization completeness assessments to children aged 11–23 months in the survey. Consequently, the precision of estimates of immunization coverage was compromised. We expect that the increased scope of understanding across the broader age group compensated for the loss of immunization completeness precision. Modeling variations in immunization utilization across different socio-economic and demographic factors were greatly constrained by the relatively small sample size of the survey. This limited the power to detect statistically significant differences in vaccination use resulting in the mostly descriptive nature of reported findings.

There is a likelihood of recall bias, especially since children under 5 years of age were taken into consideration. Caregivers cannot be expected to recall number of immunization doses with precision and figures given may approximate immunization commencement rather than completion.

We did not collect quantitative data on AEFI—this could have added more value to the study.

Recruitment of the respondents for the FGDs was carried out by the research assistants in consultation with community stakeholders. Though confidentiality and privacy were assured, social desirability, and recall bias regarding immunization utilization in the wards cannot be ruled out completely.

Conclusions

Immunization utilization and coverage in Remo North is driven by interlinked community and health services issues—a finding characteristic of this complex adaptive system—and points to the importance of actors at both supply and demand levels to be involved in the immunization service delivery and interventions. Intervention approaches should ensure that community priorities are addressed and strategies adjusted to suit contexts.

Data Availability Statement

The data that support the findings of this study are available from the Royal Tropical Institute, The Netherlands; the Ogun State Government in Nigeria and the grant funders. The data are available on request.

Ethics Statement

Ethical approval was obtained from the University of Ibadan, University College Hospital Ethics Board (UI/UCH Ethics Committee assigned number UI/EC/15/0447). Informed consent was obtained from all the study participants. Privacy and confidentiality was assured for all respondents. Additionally, permission for the study was granted at three levels—the state Primary Health Care Development Board/Ministry of Health, the Remo North LGA and from the Community through established Community Development Associations.

Author Contributions

NA and MD contributed substantially to the study design, data analysis, interpretation of findings, drafting of the manuscript, and critical revision of drafts. JB contributed substantially to the interpretation of findings and critical revision of drafts. NA, EO, and OP were involved in the field work and data collection. EO, OP, and AA contributed to data analysis and drafting of the manuscript. All the authors approved the final manuscript.

This study was funded by two grants. The grant (TW10.1054) for the Formative Evaluation of a Participatory Action Research (PAR) on immunization was awarded by the International Initiative for Impact Evaluation (3ie) and Bill and Melinda Gates Foundation. The grant (WHO TSA Contract 201410091), for the PAR was awarded by the Alliance for Health Policy and Systems Research (AHPSR), UNICEF, and GAVI. This study served as the baseline for both projects.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

The authors acknowledge the support of Dr. Ente Rood of the Royal Tropical Institute in the statistical analysis of this study. The authors also thank Dr. Monica Jain, Ms. Minna Madhok, and Ms. Avantika Bagai of 3ie; Dr. Nhan Tran and Ms. Arielle Mancuso of the AHPSR and Dr. Alyssa Sharkey of UNICEF and for all the support provided during Formative Evaluation and PAR projects. We are grateful to Mr. Olukayode Runwese, Mr. Adedoyin Oniyitan, and Miss. Olanike Fapohunda of the Ogun State Primary Health Care Development Board for all their support during the field work for this project.

1. ^ This percentage is because of target population issues due to faulty denominator – the last national census was in 2006.

2. ^ © Copyright IBM Corporation 1989, 2012.

3. ^ © QSR International Pty Ltd.

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Keywords: immunization, utilization, vaccine hesitancy, community links, health services, household decision-making

Citation: Akwataghibe NN, Ogunsola EA, Broerse JEW, Popoola OA, Agbo AI and Dieleman MA (2019) Exploring Factors Influencing Immunization Utilization in Nigeria—A Mixed Methods Study. Front. Public Health 7:392. doi: 10.3389/fpubh.2019.00392

Received: 01 September 2019; Accepted: 04 December 2019; Published: 20 December 2019.

Reviewed by:

Copyright © 2019 Akwataghibe, Ogunsola, Broerse, Popoola, Agbo and Dieleman. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Ngozi N. Akwataghibe, n.akwataghibe@kit.nl

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

List of 350 Brilliant Nursing Research Topics to Investigate in 2024

Nursing education is challenging. Writing hundreds of tedious nursing research pieces is the most frustrating part. But we know how to help you! Discover 350 exciting nursing research topics and learn how to choose the best one.

• Primary Care Topics
• Public Health Topics
• Emergency Nursing Topics
• Midwifery Topics
• Neonatal Nursing Topics
• Pediatric Research Topics
• Nutrition Topics
• Mental Health Topics
• Healthcare Management Topics
• Medical Ethics Topics
• Nursing Leadership Topics
• Qualitative and Quantitative Research
• How to Choose a Nursing Topic

Process of Nursing Research

350 interesting nursing research topics.

Nursing research topics for college students can cover various areas of this field. Below you will find a list of 350 exciting ideas, which we have divided into different areas of activity. No matter what nursing research is in your sphere of interest. We’ve got you covered! You can also check research essay samples on the same topic for more inspiration.

Primary Care Research Topics

Primary care is the leading clinical service that sustains the health of an entire nation. The study of this topic is mandatory for the stable development of the healthcare system. Here are primary nursing research titles examples:

• What healthcare problems can be in primary care?
• The role of private health care providers in primary care.
• Peculiarities of vaccination in rural areas.
• Basic methods for assessing the quality of primary care .
• The role of modern technology in primary care .
• Basic techniques of evaluating the patient’s health .
• Private sector activities in primary care .
• The necessity to provide childcare services.
• Primary care and chronic pain problem .
• Vaccination programs : pros and cons.
• The role of social workers in primary care.
• Responsibility of the pharmacist for public health.
• Effective methods of asthma prevention.
• Advantages and disadvantages of home nursing care.
• How can primary care system help fight depression?
• Vaccination of the elderly: challenges and potential benefits.
• Principles of preventive medicine: primary care for the elderly.
• Migraine diagnosis and treatment methods.
• Innovative methods in cardiology .
• Major causes of anxiety disorders in adults.
• The problem of obesity treatment in primary care .
• Effective ways of taking anamnesis.
• Methods for diagnosing stroke in the elderly.
• Basic precautions for Parkinson’s disease .
• Basic requirements for intensive care .
• Connection of primary care and information technology training .
• Sleep disorders in women.
• Standard protocol for the treatment of headache in adults.
• Basic guidelines for primary care for disaster victims.
• The role of government agencies in primary care.

Based on previous papers, you can try to come up with your nursing research topics, for example, on infection control.

Research Topics in Public Health

The public health area has a strong connection with government issues. However, it is doctors who study the basis of all problems. So, let’s check out these special nursing research paper topics!

• The role of governmental organizations in the public health system .
• Effectiveness of government programs to prevent drug addiction .
• What role do parents play in promoting children’s health?
• Features of the school nurses’ work.
• The importance of proper nutrition and exercise .
• Telemedicine : advantages and disadvantages.
• The role of government in providing nursing education .
• The importance of long-term care facilities to the healthcare system .
• Discovering public health’s primary functions .
• Promoting healthy lifestyle in old age.
• Sedentary change programs for adolescents.
• Educational strategies for healthcare organizations in social media.
• Ways to educate young people about a positive body image .
• Formation of public behavior in the problem of cancer prevention.
• Occupational health and safety for workers in hazardous professions.
• Connection of modern technologies and public health system .
• Government AIDS awareness programs.
• State programs to increase awareness of heart disease .
• Government programs aimed at maintaining a healthy work environment .
• Health promotion methods.
• Companies against alcohol: examples from history.
• Public health policies: sugary drink tax .
• Raising awareness of the importance of vaccines .
• How is lung cancer related to air condition?
• Promotion of activity among children with disabilities .
• Disease eradication as a leading public health policy target .
• Government mental health awareness programs.
• Improving individual health as a way to counter epidemics .
• Ways of transmission of infectious diseases .
• Educating children about the importance of sports .

Public health is an excellent topic choice for a nursing dissertation. Try it!

Emergency Nursing Research Topics

New studies are essential for new practical approaches for nurses in emergencies. Try to discover new methods with these critical care nursing research topics!

• What role can stress play in emergency nursing?
• How to deal with anaphylactic shock?
• Effective methods of providing emergency care .
• Features of decision-making by a nurse in critical situations.
• Analysis of the effectiveness of emergency assistance in case of accidents.
• Analysis of the extreme degrees of pain in a patient.
• Diagnosing problems in ER.
• Emergency training methods.
• How to increase chances to save a drowning person?
• Models for reducing violence in emergency departments .
• The problem of rural residents’ access to ambulance services.
• Can family stay close to the patient during resuscitation?
• What effect do tasers have on the development of heart disease ?
• Diagnosing sepsis in emergencies.
• Effective methods of dealing with the effects of using pepper sprays.
• Screening for alcohol and drug addiction in adolescents.
• The role of ambulance crews in the fight against human trafficking .
• Identification and assistance to victims of violence.
• How to deal with unwanted patient behavior?
• Pediatric trauma and shock.
• Psychiatric screening in first aid cars.
• Ways to develop tolerance in first-aid workers.
• Effective ER worker behavior models.
• The role of private clinics in providing emergency services.
• The role of nurses in the ambulance crew.
• Common causes of death in ER patients.
• Correct gender policy towards ER staff.
• How to organize a working emergency care system?
• How to help relatives survive the death of a patient?
• Techniques for teaching nurses to diagnose and respond to life threats quickly.

These nursing research topics for critical care would be an excellent choice for your papers!

Midwifery Research Topics

Midwifery is one of the more challenging medical areas. We picked 30 of the best nursing research topics on pregnancy and prenatal care to help you improve your knowledge! Take a look:

• How can midwifery recognize domestic violence?
• Excess weight problems during pregnancy .
• How to analyze the effectiveness of childbirth ?
• Disease prevention during pregnancy.
• Effective methods of newborn resuscitation.
• Features of adolescent education in gynecology.
• Prenatal nursing care.
• Precautions for preterm labor.
• Rules of conduct for staff in the delivery room.
• Basic rules for saving mother and child.
• Preparing staff and the patient for a caesarean section.
• Preventing depression during pregnancy .
• Features and importance of family planning .
• Childbirth in water: advantages and disadvantages.
• Features of caring for pregnant women with breast cancer .
• The influence of the autonomic nervous system on the course of pregnancy.
• Methods for predicting preeclampsia.
• Diseases of the cervix associated with human papillomavirus .
• Frequency and possible complications of pregnancy and cervical disease.
• Treatment tactics of pregnancy complications in women with disorders of the upper urinary tract.
• Identifying asymptomatic pregnancy complications.
• The use of modern technologies in the treatment of fetal diseases.
• Features of the reproductive system after termination of pregnancy.
• Reasons for using iodine supplementation during pregnancy.
• Prevention of complications after operations on the pelvic organs .
• Impact of epilepsy on reproductive health .
• Features of reproductive behavior in students and ways to correct it.
• The effect of oral contraceptives on the contents of immune complexes in the blood.
• Operative delivery and influence on the child.
• Psychological assistance to patients with infertility .

Remember some of these nursing research topics on midwifery. Profs love them!

Neonatal Nursing Research Topics

Neonatal studies are one of the most innovative medical spheres. Check out this brilliant list of research topics for nursing students in the neonatal area. They will help you better understand the neonatal care importance.

• The importance of hand hygiene in neonatal units .
• Features of neonatal practice in rural areas.
• The leading causes of child mortality .
• How neonatal care has evolved in recent decades.
• Hygiene of newborns and skincare for babies.
• Postpartum infant care basics.
• Principles of breastfeeding infants.
• Predicting feeding problems and treatments.
• The leading causes of seizures in newborns and methods of treatment.
• Eating disorder in infants.
• Methods for predicting diseases in newborn children.
• Effective medical practices for babies.
• Nursing ethics for newborn care.
• Features of modern neonatal practices.
• Features of the development of the pulmonary tract of newborns.
• Studies of the lungs of a newborn: functions and structural features.
• Influence of inflammatory processes on the infant’s brain.
• The role of biomarkers in the diagnosis of traumatic brain injury in infants.
• The importance of neonatal health services.
• Basic strategies for modeling neonatal education.
• Monitoring the quality of neonatal services.
• Influence of neonatal care on the further treatment of a newborn.
• Impact of maternal obesity on infant development.
• Causes of abnormal neurological development in children.
• Use of hormones to regulate fetal lung development.
• Diagnosis of diaphragmatic hernia in infants.
• Potential lung disease in premature babies.
• Using nitric oxide to treat premature babies.
• Parental drug use and effects on fetal neurological development.
• Use of biomarkers for neonatal sepsis.

A nursing dissertation on neonatal issues is always a wise choice!

Pediatric Nursing Research Topics

Studies in pediatrics are aimed to help students discover children’s health issues to solve. Innovative approaches are mandatory to fight modern challenges. Check out these research topics for nursing students; they’ll help you become more informed:

• The importance of self-care nursing in pediatrics.
• Features of the treatment of children with autism .
• Childhood obesity problem.
• Features of vaccination of minors.
• Therapy for speech disorders .
• Causes of diabetes in young people.
• Music therapy and phlebotomy.
• Suboptimal diabetes: causes and methods of intervention.
• Causes of increased fatigue in adolescents.
• HIV prevention in adolescence.

• Preventing unwanted teenage pregnancies .
• Features of the use of painkillers in children.
• Methods for analyzing adolescent behavior.
• Features of the work of the pediatric department in schools.
• The importance of health promotion in pediatrics .
• Ways to connect with your child.
• Pediatric care basics.
• How can a healthcare professional deal with adolescent aggression ?
• Reducing the risk in children receiving oxygen therapy .
• The role of molecular markers in the diagnosis of childhood leukemia .
• Psychological help for children with cancer .
• Assessment of language models in children with autism .
• The use of stem cells in the treatment of childhood diseases.
• How do environmental problems affect the development of a child’s body?
• Implications of passive smoker syndrome for children.
• Possible complications of measles in children .
• Methods for diagnosing asthma in children .
• Common causes of Tourette’s syndrome in children.
• How does anorexia affect cognitive function in children?
• Diagnosis of ear infections in childhood.

We guess this ultimate list of research topics in pediatric nursing will be helpful for you!

Nutrition Research Topics for College Students

The eating habits of modern people can be harmful to the body. Therefore, doctors are seriously studying the current problems in this area. Here you can find tons of excellent nursing research topics on nutrition and its possible issues.

• What are referral reasons for the dietary assessment?
• Nutrition assistance for the elderly.
• Effects of stress on childhood metabolism .
• Prevention of obesity in adolescents.
• Linking diet to behavioral changes.
• How social media influences teen food choices .
• Patient nutrition problem in healthcare policy .
• Predicting and assessing diabetes .
• The problem of dietary intervention in the elderly.
• Promoting healthy eating as a way to fight obesity.
• Nursing promotion of healthy homemade food.
• Effects of good nutrition on fetal development .
• How does nutrition affect a child’s development ?
• Root causes of weight gain : a clinical study.
• Common diseases caused by poor nutrition .
• Nutrition screening for the elderly.
• The nutritional problem of children with autism .
• The importance of proper nutrition during pregnancy .
• Baby food: preventing eating disorders.
• Diet as a cause of dementia development in adults.
• Osteoporosis : the role of diet in disease prevention.
• The role of diet in healthy aging.
• What is the relationship between cancer and diet ?
• Nursing role in the safety of nutrition.
• The main benefits of a healthy diet : advice to patients.
• The role of parents in maintaining healthy eating habits in children.
• The relationship between healthy eating and cognitive development .
• Modern trends in youth nutrition.
• The nurse’s role in maintaining quality nutrition for pregnant women .
• Innovative nursing nutritional care.

Now let’s move to the next section – research topics in mental health!

Mental Health Nursing Research Topics

Mental health problems are more relevant now than ever. According to the National Alliance on Mental Illness , nearly 20% of the US adult population suffers from mental health problems. That’s why psychiatry research topics capture the interest of college students.

• The importance of nursing in mental health safety .
• Features of mental disorder in alcohol dependence .
• How does police work affect mental health?
• The connection between video games and the development of teenage aggression.
• How is schizophrenia diagnosed?

• Main theories in mental health studies .
• Features of bipolar mental disorder .
• Causes and prevention of drug addiction .
• Mental health problems of athletes after physical injuries .
• Conditions for the use of psychotherapy .
• Reasons and methods for tackling health imbalances.
• The influence of phone usage on mental health .
• Brain stimulation techniques.
• Diversity of sexual orientation psychology features.
• Methods for dealing with physical violence.
• The effectiveness of traditional methods of treating mental illness .
• Features of mental support for the patient’s relatives.
• The role of nurses in the management of geriatric patients with mental disorders.
• Combating burnout in the practice of healthcare professionals.
• The problem of war veterans’ mental health .
• The phenomenon of occupational deformation as a type of mental disorder.
• Chest pain as a symptom of mental health problems in adults.
• The relationship between increased risk of cancer and depression.
• Basic treatments for dementia .
• Nursing refugee mental health help .
• The practice of mirror therapy in rehabilitation.
• Methods to help victims of violence.
• Helping patients after a stroke .
• The use of antipsychotics : benefits and harms.
• How belly massage helps fight residual stomach volume.

We believe you’re going to find one of the best psychiatric nursing research topics!

Healthcare Management Research Topics

The effective functioning of the health care system is impossible without competent leadership. Therefore, nursing research study topics on healthcare management are as important as the others!

• The importance of financial management for the healthcare industry .
• Assessment of the economic component of primary health care .
• How does bias affect healthcare funding?
• How to properly organize health care at home?
• The Importance of a Unified Nursing Code.
• How risk management affects healthcare projects?
• Gender policy in health management .
• Features of the initial stages of private medical practice.
• The importance of the apology law.
• Features of selling medical marijuana .
• Features of healthcare contracts.
• The problem of human resources in the healthcare industry .
• The problem of the shortage of men in healthcare.
• Medicare : how to get benefits.
• How to improve the minimum level of nursing training ?
• Modern trends in the healthcare management area .
• Staff uniform rules.
• Legal risks of medical personnel .
• Gender bias in nursing.
• Features of the organization of the first aid service in private sector.
• Risk management in healthcare.
• The connection of healthcare and conflict management .
• Ways to solve staffing problems in healthcare.
• Ensuring the personnel safety from infectious diseases .
• Strategies to improve the emotional health of employees.
• What is the danger of not having enough nursing staff for patients?
• Personnel policy in public medical institutions.
• International nursing training.
• Basic principles of management in healthcare facilities.
• Possible ways to get a nursing promotion.

These nursing research titles on healthcare management will impress your professors!

Medical Ethics Research Paper Topics

Controversial issues in the field of medical ethics are felt more and more acutely every year. That is why they need to be solved, and research topics related to nursing ethics present a good opportunity for highlighting them:

• The role of ethical values in the nursing decision-making process .
• Particular ethics of data collection in primary care.
• The ethical dilemma of abortion.
• Moral choice in opioid addiction .
• Features of ethics in helping the homeless .
• Ethics of care for patients with mental disorders .
• Phantom pain phenomenon.
• Features of cultural perception in the work of nurses.
• How can religious beliefs affect medical ethics?
• The role of relatives in the treatment of geriatric patients .
• Ethics of the need to increase sales in medicine.
• The problem of sexualizing the image of a nurse.
• The importance of solving moral dilemmas in nursing .
• Assisting female patients by male nurses .
• What are the main medical ethics principles?
• Ethics of care for geriatric patients.
• The problem of compulsory vaccination : solutions.
• The dilemma of artificial feeding of patients.
• Ethics of nursing in preventive medicine.
• The importance of a hospital work ethic.
• The U.S. standard of ethics for nursing .
• The dilemma of medical ethics .
• The difference in medical ethics in Asian countries and European countries.
• How can medical ethics conflict with religious beliefs?
• Assisting suicide as a dilemma in medical ethics.
• The ethical problem of marijuana usage for medical purposes .
• The impact of cultural patterns on medical ethics .
• Child maltreatment : a medical ethics dilemma.
• Implementation of international medical ethics standards for healthcare development.
• Methods for monitoring compliance with medical ethics.

Nursing ethics research questions have a tendency to be the most interesting ones!

Nursing Leadership Paper Topics

The principle of developing leadership among nurses is vital for improving the performance of any clinic. This list consists of 30 nursing research topics about leadership in healthcare field:

• What role does leadership play in nursing?
• Which skills are necessary for effective nursing leadership performance?
• The nurse’s role in providing quality health care .
• Why is it important for nurses to attend medical conferences?
• Features of the classification of nurses.
• What is a retention strategy for experienced nurses?
• How does nursing leadership development affect patient outcomes?
• The problem of obtaining a diploma for a nurse.
• Nursing leadership : key challenges and opportunities.
• Ethical issues in nursing leadership .
• Protecting staff interests in nursing management .
• Analyzing college students’ nursing leadership experience .
• Effective nursing leadership styles .
• Ways to develop nursing leadership in private healthcare facilities.
• Nursing manual: Betty Newman theory.
• The importance of intuitiveness in the workplace.
• The importance of conflict resolution in the nursing leadership sphere .
• Patient advocacy opportunities for the lead nurse.
• Nursing manual: theory of intellectual capital.
• Effective models of professional practice in nursing.
• Professional opportunities for nursing graduates in nursing leadership .
• What are modern approaches in nursing leadership?
• Transformational leadership model for nursing.
• Fundamental theories for effective nursing leadership .
• Methods for applying leadership theories to nursing .
• What is the need for effective nursing leadership ?
• Methods for monitoring the effectiveness of nursing leadership .
• Principles of delegation of authority in nursing leadership practice.
• The importance of nursing leadership in strategic hospital planning.
• Nursing leadership as a method to retain experienced staff.

Evidence-based nursing topics on leadership can become a great start to your career!

Easy Topics for Nursing Qualitative and Quantitative Research

The division into qualitative and quantitative research can be confusing. But don’t worry, we’ll help you figure it out! Each type of nursing research topic and other materials may depend on dry numbers or subjective opinions. Keep reading for more detailed information and examples of quantitative and qualitative research topics in nursing!

Qualitative vs. Quantitative Nursing Research

Empirical research methods can be divided into two broad categories: quantitative and qualitative. As their name suggests, each view relies on specific types of data. Therefore, your nursing paper topics can also reveal either qualitative or quantitative aspects of the problem. Let’s take a quick look at the main differences between these two methods.

The quantitative method relies entirely on numbers and statistics. Your task is to find patterns and come to a conclusion by analyzing a large amount of data. This type of nursing research is as structured and objective as possible. These are the quantitative method characteristics:

• Sources of information are polls, reviews, records, documents.
• The deductive methodology involved.
• As objective as possible.
• The main content is numbers and data.
• Validity depends on the selected analysis tools.

The qualitative method , on the contrary, is a reflection of the author’s thoughts and conclusions. It depends entirely on the depth of understanding of the problem and the existing materials on the nursing thesis topics. The task of the researcher is to analyze previous works and create their theory through reflection. Check the qualitative method characteristics:

• Sources of information: focus groups, document reviews, interviews.
• The inductive process is involved.
• The subjective opinion of the author is allowed.
• The main content is text and reflections.
• Validity depends on the skill of the author.

You can check lists of topics for nursing research ideas in these spheres below!

Qualitative Nursing Research Topics

Qualitative analysis is a complex but critical aspect of medical practice. Nursing qualitative research topics are designed for students to develop skills of analyzing challenging issues and make proper conclusions:

• The role of technology in improving the quality of nursing care .
• Empowering nurses to prescribe: advantages and disadvantages.
• The problem of equality between doctors and nurses .
• Nursing stereotypes.
• Issues of accreditation of medical schools.
• The problem of systemic racism in the healthcare system.
• How nursing has changed in the 20th and 21st centuries.
• The importance of nursing staff in primary care .
• Priority of cancer in adults.
• Advantages and disadvantages of qualitative research in nursing .

These qualitative nursing research topics can help you improve your analytical skills significantly!

Quantitative Nursing Research Topics

Quantitative type of scientific work is all about statistics, percentages, and numbers. Prepare yourself to analyze tons of information with these nursing quantitative research topics:

• Evaluation of the effectiveness of primary patient care.
• The leading causes of heart disease .
• Analysis of the efficacy of telemedicine .
• The problem of an overabundance of information noise in the modern world.
• Evaluation of methods of assistance in suicide attempts.
• Statistical analysis of the benefits of diets .
• Causes of mental illness in women.
• Using unconventional methods to treat diabetes .
• Benefits of probiotics for treating diarrhea .
• Methods for assessing pain in critically ill patients.

For a successful paper, it’s importnt to pick a good research topics for nursing students based on quantitative evidence.

How to choose a Nursing Research Topic?

Choosing a quality nursing research topic idea can be a daunting task. This is mainly because the variety of possible options is simply too large. But don’t worry, here are some simple tips to help you choose the theme that’s right for you!

📜 Remove large-scale topics . You should not waste your energy on massive topics. Instead, choose narrow evidence-based ideas that allow you to focus on one issue. 📜 Use personal experience . One cannot be informed in all aspects of medicine. So when you write about a topic you have no experience with, you risk getting bogged down in hours of tedious research. Try to remember what problems you faced yourself. This way, you will already have a basic knowledge of the topic. 📜 Review literature . A large amount of ready-made research a topic will be an excellent help in writing about it. Try to do a systematic nursing topics review to find more examples. This does not mean that you should copy the work of another medic. On the contrary, it will be a good opportunity for you to highlight additional information. Therefore, before choosing from easy nursing research topics, look at how much information is already in the public domain.

What is the process of nursing research? Oh, that’s a tricky question. Let’s look at the main stages you need to go through!

✨ Define the research problem . To solve a problem, you first need to find it. That is why the first thing you should do is choose a nursing research question. If you have any experience with the topic, that will be a big plus! ✨ Develop hypothesis . Now, you need to think and create your theory. It can be of any form. The main thing is to make a connection between the data pieces and find a pattern. Of course, the hypothesis must be consistent with the current nursing research topics. ✨ Literature review . Before you start writing, it’s important to tighten your knowledge of the central thesis of the topic you’ve selected. Try reading other people’s research, finding the statistics you want, and just surfing the internet. ✨ Prepare an outline . It is essential to formulate a plan for your work before you start working on it. The more detailed you describe each paragraph of your article, the less time you will need to write it. Quality work begins with a quality plan! ✨ Conduct research . Now you start the longest and most important part of the whole nursing project. You should delve deeper into the problem and find the information you need. Everything that you write should help you prove your hypothesis in one way or another. ✨ Make a conclusion and develop further recommendations . After you have processed all the material, it is time to write a conclusion. Here, you must indicate whether you have succeeded in proving the hypothesis and recommend the application for your scientific work.

Congratulations, you did it! Writing a good paper is not that difficult. It all depends on a well-chosen research topic in the nursing field; luckily, you have a list of 350 topics to look through in this article! You can find more nursing research ideas on our website!

❓ What Is Translational Research in Nursing?

Translational research is a kind of scientific work, and its task is to transform theory into new practical approaches. In other words, discoveries made in laboratories become the basis for creating a new actionable framework in nursing.

❓ What Is an Example of a Clinical Question?

The clinical question is an integral part of your scientific work. It can relate to categories such as the cause of the problem, the manifestation of the disease in the patient, possible solutions, and potential results. A well-formulated clinical question helps you write a quality article.

❓ How to Determine Level of Evidence in Nursing Research?

Several criteria determine the level of evidence in nursing research. These include quality of design, validity, and applicability of results to patient care. Therefore, you should constantly monitor the reliability of your sources and the correctness of your conclusions.

❓ What Are Some Controversial Issues in Nursing?

In modern nursing, there are some controversial issues, mainly of an ethical nature. Such problems include the issue of vaccination of people who are against it, artificial nutrition, opioid addiction, and others. There is a lively discussion about how to act correctly in some instances and what factors the decision may depend on.

📎 References:

• Evidence-Based Practice: PICO. Duke University .
• Asking the clinical question. Penn State University
• Evidence-Based Practice Toolkit. Darrell W. Krueger Library
• Top 5 Ethical Issues in Nursing. American Mobile
• Differences Between Qualitative and Quantitative Research Methods.
• Qualitative vs. Quantitative Research – What Is the difference? Imotions
• The Seven Steps of the Research Process. Teacherph
• Research Paper Writing Guide. Grammarly
• Choosing a research topic. Florida Gulf Coast University
• Nursing Process. NCBI
• Sample Research Topics. CFAES
• Selecting a Research Topic: Overview. MIT Libraries
• Three Important Nursing Subjects Students Should Know. Distant learning systems
• Evidence-Based Practice Tutorial: Asking Clinical Questions. University of Maryland
• Top 5 Ethical Issues in Nursing. Avant Healthcare
• Ethical Issues in Nursing: Explanations & Solutions. Duquesne University
• Clinical & Translational Research. UNC
• Writing a Thesis for Nursing School | Nursejournal.org
• A practical approach to the process of writing a dissertation. Nursing Times
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290+ Nursing Research Topics & Project Ideas for College Students in Kenya

Every college student dreads the process of coming up with a novel nursing project idea. It takes a lot of brain power to put together a research project that will wow the professors and earn you excellent grades. That is why I have put together this list to help you narrow down your search and come up with an excellent project topic regardless of your area of specialization.

Nursing Leadership Project Ideas for College Students in Kenya

• Nurse leadership: Passion or Duty?
• Role of transformational leadership among nurse managers
• Significance of communication among interprofessional team nurse leaders
• Management styles in nursing
• Improving nursing leadership skills
• Interview with a nurse leader
• Strategies to Address the Shortage of Respiratory Therapists and Ventilators during Disaster (Covid19 Pandemic Case Study)
• Strength and weaknesses of charge nurses
• Importance of charismatic leadership among nurse leaders
• The stress management approach for nurse leaders
• The role of charismatic leadership among nurse leaders
• A comprehensive study of the problems facing modern nurse leaders
• Effective use of organizational tactics to motivate healthcare personnel
• Professional development strategies for nurses
• Importance of ethical practice among nurse leaders
• Impact of nurse leadership on patient outcomes
• Significance of nurse leadership
• What is leadership from a nursing perspective?
• Long term and short-term goals for clinical leaders
• Theories that support nurse leadership
• Importance of nurse leaders in quality improvement projects
• How nurse leaders can initiate and manage change
• The link between nurse leadership and change management
• Impacts of nurse engagement and inclusion on patient outcomes
• Organizational strategies nurse leaders can use to motivate the healthcare personnel
• Challenges facing contemporary nurse leaders
• Role of nurse leaders in solving conflicts in clinical settings
• Nurse leaders as patient advocates
• Role of nurse leaders in preventing violence in emergency rooms
• How nurse leaders can address burnout among nurses
• Importance of having a personal leadership philosophy as a nurse leader
• Leadership in the Kenyan Health system
• Influential nurse leaders in the political space
• Role of nurse managers in healthcare
• Nurse leadership qualities and behavior
• Traits of a great nurse leader
• Comparing and contrasting nurse leadership roles in private and public hospitals.
• Difference between accountability among nurse leaders in developed nations and developing nations
• Nurse leaders as change agents in healthcare settings
• Effective nursing leadership styles
• Leadership in nursing education
• Student nurses and leadership
• Top qualities of a great nurse leader
• Evaluation of leadership qualities the deliver excellence in a nursing setting
• Productivity of nurse leaders in public versus private hospitals
• Emergency room conflict and the role of nurse leaders in resolving it
• Effective strategies charge nurses can implement in addressing stress and burnout among nurses
• Role of nurse leaders in shaping public policy
• Leadership characteristics that represent excellence
• Defining leadership in nursing
• Training plan for nurse leaders
• Transactional leadership approach among nurses
• The future of nurse leadership
• How nurse leaders can ensure team leadership for the best collaboration in healthcare teams
• Impact of recognition program on Registered Nurses motivation level
• Pharmaceutical Companies Overpricing Medication: Background and Policy Landscape
• The Roles of Nursing Organizations in Shaping the future of nursing

Nursing Informatics Capstone Project Ideas for College Students in Kenya

• Adoption of e-learning in healthcare management
• Adoption of transformative technology such as CDSS in clinical settings
• The use of big data in clinical research
• Use of electronic medical records in acute care
• Significance of mHealth apps on mental health care access by rural populations
• Nursing Faculty Perceptions on the Use of Computer-Based Virtual Simulation in an Associate Degree Nursing Program
• Developing and Improving the safety and security of patients through comprehensive data research
• Methods for storing and keeping nursing informatics data
• Data governance in healthcare settings
• Impacts of a healthcare data breach
• Use of Healthcare Information Technology to support evidence-based practice in nursing
• Importance of clinical support decision making systems
• The use of technology to bridge the nurse shortage gaps in rural areas
• Electronic health records in healthcare
• Nurse informatics competencies
• Meaningful use and HIT
• Priorities for informatics investment in the future
• Utilization of modern-day systems for reliable nursing information
• Collaborative decision making through shared governance in healthcare
• Ethics and data management in healthcare
• The use of big data in healthcare settings
• Robotics in surgery
• The use of electronic health records to offer patient-centered care
• Assisting recovering centers
• Role of nursing informatics in quality improvement
• E-learning as a professional development approach among nurses
• Advantages and disadvantages of the current health records system
• Current situation of nursing informatics in developing countries
• Impact of nursing informatics on the quality of nursing services
• HITECH Legislation and Electronic Medical Records in healthcare
• Health Information as a strategic resource in the Australian settings
• The Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies
• Healthcare management information system
• Developing digital literacies for nursing school students
• Barriers to competency development in nursing informatics
• Integrating health informatics to nursing education
• The use of smartphones in inpatient management and education
• The use of simulation for nursing students

Nursing Practice Project Ideas for College Students in Kenya

• Oxygen Use in Patients with COPD
• Measuring Blood Pressure Noninvasively in Children
• Intravenous Catheter Size and Blood Administration
• The historical perspectives on evidence-based nursing
• The ethical side of abortion care
• Adolescent education in gynecology
• Preparations for cesarean section
• Rules for infant resuscitation
• Checklist for delivery list behavior
• Recommendations for prenatal care
• Dealing appropriately with foreign patients
• Data collection ethics in primary healthcare
• Stress management practices for nurses on a night shift
• How to apply the Nurse Bedside Shift Report
• How experience and education impact medication mistakes for Registered nurses
• Consequences of intentional sabotage and bullying for nurses at the workplace
• Analysis of nursing behavior towards HIV and Aids patients
• Psychiatric care and mental health issues in adults
• Productive programs for obesity and weight management among seniors
• A case study of joint disorders in the elderly population
• Interventions for managing socially impaired behavior among adult patients with dementia
• Utilizing technology to boost the safety of patients in nursing homes

Nursing Project Topics for Primary Health Care Research for College Students in Kenya

• Health financing strategy
• Effectiveness of honey-based products in wound care
• Medical staff attitude and knowledge about in-patient falls
• Patient fall rates in the acute care in-patient hospitals
• Patient fall education and patient safety
• Nurse education on patient falls and safety culture
• Strategies to reduce patient injuries from falls
• Fall prevention practices at home
• Evidence-based practice falls intervention strategies in hospital settings.
• The use of video and camera monitoring to prevent falls among elderly patients
• The use of technology in fall prevention
• Role of hospital leadership in preventing patient falls
• Quality improvement program for reducing falls in medical-surgical units
• Factors contributing to psychiatric patient falls in hospitals
• Creating a safety culture that prevents falls
• Multifactorial fall risk assessment
• Healthcare Managers Role in Fall-Related Injury Prevention in Assisted Living Facilities
• Fall risk among osteoporosis patients
• Multifactorial interventions for the prevention of falls among elderly patients
• Use of exercise in reducing falls among elderly patients
• The Morse fall risk scale and its significance in fall risk assessment and management
• Characteristics of at fall risk patients
• Using engineering controls to prevent falls among patients and the elderly
• Outpatient fall risk assessment tool
• Effects of implementing evidence-based fall risk scale on fall rates
• Standardized fall risk assessment tool
• Prevention of patient falls through education
• Fall prevention strategies in home settings
• Fall prevention strategies in hospitals
• Potential causes of falls in hospitals
• Defining fall and fall risk patient
• The use of SPICES framework and FAMILY cards to assess old patients
• Nursing interventions to prevent falls
• Home environment assessment for elderly patients
• Safety awareness activities for elderly patients
• Strategies and tools to address patient falls in nursing homes
• Recommendations based on primary care knowledge
• Ethics for data collection in primary health care
• An economic evaluation of primary health care
• Methods of assessing the quality of medical care
• Environmental assessment and modification as a fall management strategy
• Home modification approach to falls management
• Impacts of the design of healthcare stings/environments on patient fall
• Physical environmental risk factors for elderly falls
• Home safety modifications to reduce fall injuries among geriatric patients
• Defining different methods to manage and process wounds
• Modern vaccination program in rural and remote areas
• Impacts of visiting home nurses on reducing in-patient falls
• Role of pharmacists in addressing patient falls
• An interdisciplinary approach to fall management in clinical settings
• Hourly Rounding and Fall Prevention among the elderly in long term care: A change process.
• The private sector in the mental health system
• Integration of childcare into basic medical care
• ER symptoms that cannot be explained medically
• The involvement of local pharmacists in the work of doctors
• Strategies to curb patient falls in a home setting
• Implementing technology in the prevention of falls among elderly patients
• Fall risk assessment among psychiatric patients

Nursing Topics on ER, Theater & Capstone Project Ideas on Mental Health for College Students in Kenya

• Causes of depression
• Alcohol addiction disorder
• Diagnosis of schizophrenia
• Bipolar disorder
• PTSD for KDF veterans
• Police stress
• Health education approach for mentally ill patients
• Addressing stigma among careers and patients with mental health issues
• Teen aggression and video games
• Use of prohibited substances
• Psychiatric patient ethics
• Methods of recovery and damage to the body
• The link between mental health issues and homelessness
• Detrimental effects of sexual assault on children
• Impacts of domestic violence on children
• The relationship between mental health and {subject of your choice}
• Evaluating readiness for psychological rehabilitation
• How autonomous decision making is affected by mental illness
• Putting postnatal depression into perspective
• Managing dementia patients with non-pharmacological methods
• The correlation between caring behavior and emotional intelligence for nurses in Emergency Rooms
• Analyzing the link between compassion fatigue and exercise among medical surgery nurses
• How to enhance safety in operating rooms
• Ways to boost patient flow in an urgent care facility
• Strategies to curb distress among isolated marrow and blood transplant patients post-transplantation
• Dealing with the aftermath of a cancer surgery

Research Topics for for College Nursing Students in Kenya

• Development of a new mental health guide for educators
• The use of cognitive-behavioral therapy techniques in psychiatric facilities
• Art therapy and mental health
• Causes of suicide among youths
• Child and adolescent psychiatry
• Substance abuse disorders
• Substance abuse among the geriatric population
• Treatment of Arthritis
•  Bedside shift report implantation
•  Preventing and managing measures of diabetes
•  HPV awareness and vaccination
•  Visitation model review
•  The link between homelessness and mental health issues
• The efficiency of Yoga in maintaining mental health wellbeing
• Use of expressive art therapy for positive youth development
• Using CBT for PTSD affected veterans
• Impact of sexual abuse on children
• How domestic violence affects the children
• Culture-based mental health programs
• Impacts of bullying at the workplace for new nurses
• Planning emergency measures
•  Optimizing of a phone app for patients who inflict self-harm
•  How ER patients are affected by color
•  Emergency salary for nurses
•  Can emergency calls be easier?
• Causes and treatment of ADHD
• Vaccination and autism
• Antibiotic resistance in preschool children
• Mental health issues among the aboriginal populations
• Understanding postnatal depression among women
• Mental health nursing for adolescents
• Mental health scales best for children in prison
• Access to mental health services by aboriginals or a specific population
• Lateral violence among nurses
• Effectiveness of mental health services for deaf service users
• Outcome measures for an inpatient with mental health issues
• Mental illness and autonomous decision making
• Psychological rehabilitation readiness assessment
• Links between heritage, arts, museums, and mental health
• Impacts of teenage suicides
• Preparing student nurses to manage trauma in clinical settings
• Mental health simulation models for ADN students
• Perception of Intellectual Disability Nurses by other nurses
• Eating disorders and their effects on social media
• Causes of seizures in infants
• Medical practices for teenagers
• Child obesity and healthy eating
• Psychological aspects of baby care
• Treatment of the acute coronary syndrome
• Obesity and weight management
• Ketamine infusion therapy
• Tobacco dependence
• Safety in the psychiatric centers
• Preventing falls in psychiatric facilities

Midwifery Topics & Women’s Health Research Project Ideas for College Students in Kenya

• Treatment and prognosis for breast cancer
• Ethical rules for infertility
• Menopause Challenge
• Impact of diabetes during pregnancy
• Relationship between HPV and cancer of the cervix
• Prevalence of fibroids and uterine cancer in women
• How breastfeeding impacts immune levels in children
• Modern infant practices
• Analysis of ovarian disorders
• The link between HPV and cervical cancer
• Mammography to detect breast cancers in women
• Gestational diabetes management
• Birth control approach among women
• Ectopic pregnancy
• Breast pumps and breastfeeding
• The use of codeine and tramadol products in breastfeeding women
• Nutritional management during pregnancy
• Management of endometriosis
• Use of supplements when breastfeeding
• Managing menopause
• Reproductive endocrinology
• Sleep disorders in women
• Women’s sexual health disorders
• Emergency contraception/ birth control
• Female genital mutilation and sexual health of women
• Impacts of fibroids on women
• Menopause in women
• Breastfeeding, work, and women of low socio-economic status
• Normal versus cesarean births
• Epidural in induced births
• Pelvic floor issues in women
• Factors that influence the decision to breastfeed
• Causes of vaginal atrophy
• Various practices of pregnant mothers and child delivery in rural areas
• Prenatal designation: first analysis
• Causes of mental illness during the postpartum period
• A review of shift midwives and study length
• Self-taught equipment and training injuries
• The importance of midwives continuing treatment
• Pregnancy challenges to gain weight
• Addressing mental health among pregnant women in rural areas
• Constipation after cesarean surgery
• Analysis of labor efficiency
• Positive experiences with childbirth
• The best safety rules for pregnant women
• Preeclampsia among women
• Postpartum depression among women
• Diabetes management during pregnancy
• Urine incontinence in women
• Uterine cancer and fibroids in women
• Postmenstrual syndrome and hormonal changes
• Smoking and pregnancy
• Infant mortality and preterm birth among African American women
• Teenage pregnancy
• Preventing pregnant women from Zika Virus

Ethical & Controversial Research Topics in Nursing for College Students in Kenya

• Examination of joint disease in the elderly
• Home treatment for patient support during chemotherapy
• Examination of atrial fibrillation
• Therapy for bladder cancer
• Cardiovascular risk reduction
• Intensive care requirements
• Geriatric ethics
• Stroke and cerebrovascular disease
• Restless legs syndrome
• Precautions for Parkinson’s Disease
• The clinical role of a nurse
•  Specialist in social work and the role of health promotion
•  Between career and professional service
•  Diversity of health services
•  Uniform code for nurses
•  Gender bias in the nursing profession
•  Shortage of men in health care
•  Legal apologies and medical decisions
•  Home medical services
•  Health contract restrictions

Pediatric & Nursing Quality Improvement Research Topics for College Students in Kenya

• The maximizing of patient outcome and cutting costs of improved management of fungal infection
•  Managing risk of the mortality rate of infant
•  Enhancing experiences of cancer patients with easy access to radiotherapy and multidisciplinary assessment
•  Employing electronic data in identifying problems of secondary care during weekends
•  Online guide or self-help for cancer and depressed teens
• Assessment of child behavior in pediatric primary care
•  Ethics in pediatric care
•  Reasons why mother’s health may be under threat during childbirth
•  Child’s health insurance: right or privilege?
•  Evaluation of childbirth efficacy

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22 Best universities for Critical Care Nursing in Nigeria

Updated: February 29, 2024

• Art & Design
• Computer Science
• Engineering
• Environmental Science
• Liberal Arts & Social Sciences
• Mathematics

Below is a list of best universities in Nigeria ranked based on their research performance in Critical Care Nursing. A graph of 32.2K citations received by 3.46K academic papers made by 22 universities in Nigeria was used to calculate publications' ratings, which then were adjusted for release dates and added to final scores.

We don't distinguish between undergraduate and graduate programs nor do we adjust for current majors offered. You can find information about granted degrees on a university page but always double-check with the university website.

1. University of Lagos

For Critical Care Nursing

2. University of Ibadan

3. Obafemi Awolowo University

4. University of Nigeria

5. Bayero University Kano

6. University of Port Harcourt

7. University of Calabar

8. Ahmadu Bello University

9. University of Benin

10. Olabisi Onabanjo University

11. University of Maiduguri

12. Joseph Ayo Babalola University

13. University of Ilorin

14. Ebonyi State University

15. Ladoke Akintola University of Technology

16. Nnamdi Azikiwe University

17. Lagos State University

18. University of Abuja

19. Usmanu Danfodio University

20. University of Jos

21. Ekiti State University, Ado Ekiti

22. Babcock University

The best cities to study Critical Care Nursing in Nigeria based on the number of universities and their ranks are Lagos , Ibadan , Ife , and Nsukka .

Medicine subfields in Nigeria

Professions in Nigeria

Nursing in nigeria: a comprehensive career guide.

Last Updated on August 12, 2023

Introduction

Nursing in Nigeria has evolved greatly over the years. From being a predominantly female profession to being one of the most sought-after careers for both males and females, nursing has taken its place as an important aspect of the healthcare system in Nigeria.

The importance of nursing as a career cannot be overemphasized. Nurses are the backbone of any healthcare system, and their contribution to the delivery of quality healthcare cannot be overemphasized. Nursing offers numerous job opportunities both locally and internationally, making it a career choice that offers job security and financial stability.

The purpose of this blog post is to serve as a comprehensive guide for prospective nursing students who are interested in starting and succeeding in a nursing career in Nigeria. It will cover topics such as the education and training required, the different types of nursing specialties, career opportunities, and the challenges of being a nurse in Nigeria.

By the end of this blog post, readers would have gained the necessary knowledge and insight needed to make informed decisions about pursuing a nursing career in Nigeria.

Read: Unfolding the Vast World of Healthcare Professions in Nigeria

Education and Training for Nurses in Nigeria

Educational requirements.

Aspiring nurses in Nigeria are required to have a secondary school certificate with credits in English Language, Mathematics, Biology/Health Science, Chemistry, and at least one other subject. In addition, they must also pass the Joint Admission Matriculation Board (JAMB) exam and its cutoff mark.

Accredited Nursing Programs

Nursing programs in Nigeria must be accredited by the Nursing and Midwifery Council of Nigeria (NMCN) to ensure that they meet the set standards for nursing education. Some of the accredited programs include a diploma, Bachelor of Nursing Science, and Bachelor of Science in Nursing.

Duration of Nursing Programs

The duration of nursing programs in Nigeria varies depending on the level of education. The diploma program takes three years, the Bachelor of Nursing Science program takes four years, while the Bachelor of Science in Nursing program takes five years.

Continuing Education and Training Opportunities

After obtaining a nursing degree or diploma, Nigerian nurses can partake in continuing education and training programs provided by various institutions. These programs aim to enhance their proficiency and competence in their professional roles. They can attend workshops, seminars, and conferences and also participate in online learning programs.

List of accredited nursing programs in Nigeria:

• Diploma in Nursing
• Bachelor of Nursing Science (B.N.Sc.)
• Bachelor of Science in Nursing (B.Sc. Nursing)

Some of the institutions offering accredited nursing programs in Nigeria:

• University of Nigeria, Nsukka
• University of Lagos
• Obafemi Awolowo University
• Ahmadu Bello University
• University of Ibadan

Continuing Education and training institutions in Nigeria:

• Nursing and Midwifery Council of Nigeria (NMCN)
• Institute of Nursing Research Nigeria (INRN)
• Nigeria Medical Association (NMA)
• West African College of Nursing (WACN)

Overall, nursing education and training in Nigeria equips nurses with the necessary knowledge and skills to deliver quality healthcare services. It is essential for aspiring nurses to select accredited programs to ensure that they are recognized by the NMCN and are legitimate. Furthermore, continuing education and training opportunities provide Nigerian nurses with an opportunity to advance their careers and remain relevant in their field.

Read: Top 10 Highest Paying Professions in Nigeria: 2023 Edition

Career Opportunities in Nursing

As a nursing professional in Nigeria, you have a wide range of diverse career opportunities to choose from in various settings ranging from public and private sectors to hospital settings and home healthcare.

Public and Private Sectors

• Working in public or private healthcare facilities, such as hospitals, clinics, and nursing homes.
• Work as a consultant for governmental and non-governmental organizations.
• Work in community health centers, schools, and other public health programs.

Hospital Settings

• Work in emergency rooms, intensive care units, medical-surgical units, pediatrics, or mental health units.
• Participate in hospital management or administration.
• Assist in medical research or clinical trials in healthcare facilities.

Home Healthcare

• Provide nursing care to patients in their own homes.
• Offer long-term care for patients with chronic illnesses or disabilities.
• Treat patients with the necessary medical equipment and devices.

Opportunities for Specialization

• Become a specialized nurse in areas such as oncology, cardiology, neurology, or geriatrics.
• Specialize in public health, community health, or occupational health services.
• Choose to become a nurse educator or researcher in the field of nursing.

Nursing Education and Research Opportunities

• Work as a nurse educator, teacher, or faculty member in nursing schools or colleges.
• Contribute to the research and development of nursing practices and methods.
• Share knowledge and expertise to advance the nursing profession through conferences, seminars, and workshops.

Overall, the nursing profession in Nigeria offers diverse and rewarding career opportunities where experienced nurses can make a positive impact on the lives of patients, families, and communities.

Salary and Benefits for Nurses in Nigeria

Money isn’t everything, but it surely helps, especially when it comes to job satisfaction. Having financial stability can relieve stress and related health issues. Here, we discuss salary and benefits for nurses in Nigeria.

The average salary for nurses

• In Nigeria, an entry-level nurse can reasonably expect to earn about ₦80,000 monthly.
• As a nurse gains more experience and advances either in education or job position, their salary can increase up to ₦300,000 monthly.
• Salary is higher for nurses who work in urban and developed areas or institutions than those in remote and poorer rural communities.

Benefit packages offered for nurses

• Most large hospitals and government agencies offer their nurses benefits package typically entailing health insurance coverage, paid vacation, sick leave, and maternity leave.
• Clinics and small hospitals may only offer limited benefits packages or no benefits at all.
• Some benefits are discretionary. For instance, commutation privileges, housing benefits, hazard allowances, and shift differentials.

Salary negotiation tips

• Salary negotiation can be intimidating, especially if you’re a new graduate or unfamiliar with salary structures.
• Research the industry standard for your level of experience, certification, and educational attainment, then request a salary alongside the standard.
• Factor in the cost of living expenses in the area where the job is located.
• Be prepared to highlight your qualifications, achievements, and any relevant experience that would add value to the organization.
• Be flexible and willing to negotiate other terms like additional annual leave, flexible work hours or remote work options, professional development opportunities, or performance-based bonuses.
• Know when to walk away from a lowball offer-accepting a lower salary than what you’re worth can negatively impact your earning potential in the future.

In essence, knowing what to expect in terms of salary and benefits can help a nurse make informed decisions about their career path and an organization that aligns with their values. Though salary should not be the only consideration when choosing a nursing job, it is essential to get paid what you are worth.

Read: Banking vs Finance Careers: Which is Best for You?

Challenges and Prospects of Nursing in Nigeria

Challenges facing the nursing profession in nigeria.

• Inadequate funding for nursing education and services
• Shortage of qualified nursing personnel
• Low remuneration and poor working conditions
• Limited opportunities for career advancement
• Poor perception of the profession by the public
• Inadequate regulatory framework for nursing practice
• Lack of support for research and evidence-based practice

These challenges have contributed to a number of negative outcomes for the nursing profession in Nigeria, including a high rate of emigration of qualified nurses to other countries and a shortage of skilled personnel to provide healthcare services to the population.

Read: Career Paths in Nigeria’s Thriving Fintech Scene

Current Efforts to improve nursing in Nigeria

• Increased funding for nursing education and services
• Expansion of nursing schools and training programs
• Revision of the curriculum to include more practical and clinical training
• Introduction of incentives such as scholarships and loan forgiveness programs for nursing students
• Strengthening of regulatory bodies such as the Nursing and Midwifery Council of Nigeria to enforce standards and maintain quality in nursing practice

These efforts are aimed at increasing the number and quality of nursing personnel in Nigeria, as well as improving the perception of the profession and encouraging more people to pursue careers in nursing.

Opportunities for growth and development in the nursing profession

• Specialization in areas such as critical care nursing, oncology nursing, and psychiatric nursing
• Career advancement opportunities such as managerial and leadership positions
• Involvement in research and evidence-based practice
• Opportunities to work in international organizations and participate in global health initiatives
• Possibility of starting private practices or consultancy services

With the increasing demand for healthcare services in Nigeria, the nursing profession presents numerous opportunities for growth and development. Nurses who specialize in critical areas and demonstrate leadership and managerial skills are highly sought after by healthcare organizations.

Essentially, while the nursing profession in Nigeria faces a number of challenges, there are also ongoing efforts to improve the quality and number of nursing personnel, as well as opportunities for growth and development in the field. These efforts will require sustained investment and collaboration between the government, healthcare organizations, and the nursing community in Nigeria.

Read: Securing Internships in Nigeria’s Top Banking Firms

Summary of key points:

Throughout this career guide, we have explored various aspects of nursing in Nigeria. From the history of nursing in the country to the current state of the profession, we have covered it all. We have discussed the educational requirements, licensing, and job opportunities available to aspiring nurses in Nigeria. Additionally, we have touched on the challenges and opportunities faced by current nursing professionals in the country.

Implications for aspiring and current nurses in Nigeria:

Aspiring nurses in Nigeria now have a comprehensive guide to help them navigate the path to becoming a licensed nurse. They can use this guide to learn about the education, licensing requirements, and job opportunities available to them in the country. Current nurses in Nigeria can also benefit from this guide by gaining a deeper understanding of the profession and the challenges faced by their colleagues.

Final thoughts:

Nursing is a noble profession that requires dedication, hard work, and a deep sense of compassion. The role of nurses in Nigeria cannot be overemphasized, especially in light of the current healthcare challenges facing the nation. By providing this career guide, we hope to inspire current and aspiring nurses in Nigeria to continue to pursue excellence in their field, delivering quality healthcare services to their patients and contributing to the advancement of the nursing profession in the country.

• Unfolding the Vast World of Healthcare Professions in Nigeria
• Role of Pharmacists in Nigeria’s Evolving Healthcare System

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• Open access
• Published: 16 April 2024

Using a priority setting exercise to identify priorities for guidelines on newborn and child health in South Africa, Malawi, and Nigeria

• Solange Durão   ORCID: orcid.org/0000-0001-7028-2638 1 ,
• Emmanuel Effa 2 ,
• Nyanyiwe Mbeye 3 ,
• Mashudu Mthethwa 2 ,
• Michael McCaul 4 ,
• Celeste Naude 4 ,
• Amanda Brand 4 ,
• Ntombifuthi Blose 1 ,
• Denny Mabetha 1 ,
• Moriam Chibuzor 2 ,
• Dachi Arikpo 2 ,
• Roselyn Chipojola 3 ,
• Gertrude Kunje 3 ,
• Per Olav Vandvik 5 , 6 ,
• Ekpereonne Esu 2 ,
• Simon Lewin 7 &
• Tamara Kredo 2 , 4  

Health Research Policy and Systems volume  22 , Article number:  48 ( 2024 ) Cite this article

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Sub-Saharan Africa is the region with the highest under-five mortality rate globally. Child healthcare decisions should be based on rigorously developed evidence-informed guidelines. The Global Evidence, Local Adaptation (GELA) project is enhancing capacity to use global research to develop locally relevant guidelines for newborn and child health in South Africa (SA), Malawi, and Nigeria. The first step in this process was to identify national priorities for newborn and child health guideline development, and this paper describes our approach.

We followed a good practice method for priority setting, including stakeholder engagement, online priority setting surveys and consensus meetings, conducted separately in South Africa, Malawi and Nigeria. We established national Steering Groups (SG), comprising 10–13 members representing government, academia, and other stakeholders, identified through existing contacts and references, who helped prioritise initial topics identified by research teams and oversaw the process. Various stakeholders were consulted via online surveys to rate the importance of topics, with results informing consensus meetings with SGs where final priority topics were agreed.

Based on survey results, nine, 10 and 11 topics were identified in SA, Malawi, and Nigeria respectively, which informed consensus meetings. Through voting and discussion within meetings, and further engagement after the meetings, the top three priority topics were identified in each country. In SA, the topics concerned anemia prevention in infants and young children and post-discharge support for caregivers of preterm and LBW babies. In Malawi, they focused on enteral nutrition in critically ill children, diagnosis of childhood cancers in the community, and caring for neonates. In Nigeria, the topics focused on identifying pre-eclampsia in the community, hand hygiene compliance to prevent infections, and enteral nutrition for LBW and preterm infants.

Conclusions

Through dynamic and iterative stakeholder engagement, we identified three priority topics for guideline development on newborn and child health in SA, Malawi and Nigeria. Topics were specific to contexts, with no overlap, which highlights the importance of contextualised priority setting as well as of the relationships with key decisionmakers who help define the priorities.

Peer Review reports

Globally, more than half of all deaths in children and youth in 2019 were among children under 5 years [ 1 ]. It is estimated that there are 5.2 million deaths among under-fives each year, with Sub-Saharan Africa (SSA) having the highest mortality rate [ 2 ]. Most countries in SSA are not on track to meet maternal and child health targets set by Sustainable Development Goal 3 to ‘ensure healthy lives and promote wellbeing’, specifically the target of 25 or fewer deaths per 1000 live births [ 1 ]. As of December 2021, under-five mortality rates were reported as 113.8, 38.6 and 32.2 deaths per 1000 live births for Nigeria, Malawi and South Africa respectively [ 3 ]. Factors accounting for regional disparities in child mortality rates include poverty, socioeconomic inequities, poor health systems, and poor nutrition, with disease outbreaks adding substantially to the burden [ 4 ].

Addressing these issues requires an evidence-informed approach to ensure that scarce resources are used effectively and efficiently, avoid harm, maximise benefits, and improve healthcare delivery and outcomes [ 5 , 6 , 7 ]. Evidence-informed practices have been growing in SSA [ 5 ], and include the use of recommendations from clinical practice guidelines that are intended to optimise patient care or public health practice [ 8 ]. Guidelines bridge the gap between research evidence and practice and are recognised as important quality-improvement tools that aim to standardise care, inform funding decisions, and improve access to care, amongst others.

The development of evidence-informed, trustworthy guidelines from scratch—also known as de novo guideline development—is a resource-intensive and time-consuming process [ 9 ]. However, guideline developers can adopt or adapt existing recommendations from guidelines developed in other settings, to make the process more efficient while maintaining transparency and minimising waste and duplication [ 10 , 11 , 12 , 13 ]. For example, the World Health Organisation (WHO) produces high-quality global-level guidelines, which may be adopted and implemented in a member country or, alternatively, adapted for that context. Guidelines can be adopted when there is no need to change the recommendation, the evidence base, or how it is implemented in a local setting while considering factors such as cost, workforce, health systems, management options and access to care [ 10 ]. They can also be adapted when there is a need to modify a guideline(s) or recommendation(s) produced in one cultural and organisational setting for application in a different context [ 10 ]. However, adaptation of such guidelines to national contexts is often not well described [ 14 ]. An evaluation of experiences of guideline adaptation across WHO regions found that adaptation is understood and implemented in a variety of ways across countries [ 15 ].

Furthermore, reporting of guidelines in the African context is usually below global standards, specifically regarding their rigor of development. Kredo and colleagues reviewed Southern African Development Community (SADC) guidelines on five specific diseases published between 2003 and 2010 and besides poor reporting they found that guidelines needed broader stakeholder involvement and greater transparency [ 16 ]. Scoping reviews of newborn and child health guidelines in South Africa, Malawi and Nigeria published between 2017 and 2022 and of pre-hospital clinical guidance in sub-Saharan Africa found that the methods and reporting of the identified guidelines do not adhere to global standards [ 17 , 18 ].

In terms of priority setting processes for guideline development in African settings, little information is available. A scoping review of studies describing prioritization exercises published up to July 2019 did not identify any studies from African countries, with most studies being from Europe [ 19 ]. There is thus room for strengthening and supporting guideline development and adaptation in SSA, including the initial priority setting for those guidelines.

The Global Evidence, Local Adaptation (GELA) project focuses on addressing some of these gaps, including improving guideline development processes in SSA. The project aims to maximise the impact of research on poverty-related diseases by enhancing decision makers’ and researchers' capacity to use global research, including existing high-quality global guidelines, to develop locally relevant guidelines for newborn and child health in three sub-Saharan Africa countries: South Africa (SA), Malawi and Nigeria. The first step of this project was to identify priorities for newborn and child health guideline development in each country, and this paper aims to describe our approach.

Priority setting methods

Priority setting is an important step in guideline development [ 9 ]. It enables the identification of the most important issues through an iterative, inclusive and explicit process [ 7 , 20 ], and ensures efficient resource use by identifying topics for which guidelines are truly needed [ 19 , 21 ].

A variety of methods and approaches for priority setting for research and for guidelines have been used in the literature but there is no existing gold standard method for priority setting [ 19 , 22 ]. Researchers have analysed priority setting exercises and proposed good practice principles that can be followed during such exercises [ 22 , 23 ]. These principles, or elements, of priority setting are linked to the different stages in the process: pre-prioritisation, prioritisation, and post-prioritisation stages, as described in Fig.  1 [ 19 , 22 , 23 , 24 , 25 ]. In the pre-prioritisation stage, they include (i) involving internal and external stakeholders in the decision-making process, (ii) use of an explicit and transparent process, (iii) information management, (iv) consideration of values and context in which the priorities are being set, including those of stakeholders, staff and patients, and (v) planning for implementation, i.e. planning for translation of the priorities into practice. In the prioritization stage they include (i) using relevant criteria to identify priorities and (ii) choosing a method to decide on priorities, which could be consensus-based, such as the 3D Combined Approach Matrix (CAM), or metric-based approaches, such as the Child Health and Nutrition Research Initiative (CHNRI) approach [ 26 ]. In the post-prioritisation phase, they include (i) an evaluation of the priority setting process, and (sii) putting in place mechanisms for reviewing decisions.

Elements of each priority setting stage (adapted from El-Harakeh 2020, Jo 2015, Sibbald 2009, Tong 2019, Viergever 2010)

We followed good practice priority setting method, as described above. Our approach included a pre-prioritisation stage to identify potential priority topics through stakeholder engagement and review of the literature, and a prioritisation stage for consultation and finalisation of the priority topics through online surveys and consensus meetings, using specific criteria (Fig.  2 ). Country teams were responsible for implementing each step in their respective countries and any differences in the process due to practical or other factors within the three countries were captured as part of the documentation of the process.

Overview of priority setting approach overview

Pre-prioritization

Stakeholder identification and engagement.

We engaged with two different pre-specified groups. The first were the members of the Guideline steering group set up in each GELA project country. Up to 13 individuals were identified and invited to participate from the relevant national departments or ministries of health, professional associations, country-level WHO offices, and any other individuals suggested by these bodies in each country. They were identified through existing contacts of the researcher team within national departments of health responsible for guideline development and working within newborn and child health area, with whom they had worked before. These individuals then also made suggestions of other members from other stakeholder groups such as academia, non-governmental organisations, etc., who worked in the field of newborn and child health. The steering group provided initial suggestions of priority topics, made the final decisions regarding which to prioritise, and provided general oversight and technical advice on the in-country implementation of the project.

The second stakeholder group was broader and included individuals or organisations who are involved, can affect or are affected by national decisions or actions related to priority topics in the field of newborn or child health in sub-Saharan Africa [ 27 , 28 ]. These included policymakers, guideline developers, health professionals, civil society representatives, patient advocacy groups as well as WHO Afro representatives, specifically those linked to potential priority topics identified. To identify them, we carried out a stakeholder mapping exercise, which included reviewing secondary data, such as existing guidance and publications and searching the websites of ministries of health, relevant professional associations, universities, NGOs and civil society groups. The national GELA Guideline Steering group members also made suggestions. This process was guided by the stakeholder power-interest matrix where those who have the most influence, and capacity to change practice for impact were prioritised and invited [ 29 ]. Participants were invited, via email, to complete a priority setting survey.

Identifying a long list of topics

We generated an initial long list of potential priority topics through (i) reviewing existing and planned WHO guidelines on newborn and child health, from which potential topics were extracted based on existing recommendations; (ii) consulting with the GELA guideline Steering Group; and (iii) reviewing the disease burden/technical data related to newborn and child health in each country, which was identified through targeted literature searches. WHO guidelines were used as a starting point as these are prepared following rigorous methods and are intended for implementation across the various member countries. Potential topics were organised according to the disease/condition being addressed and the type of intervention (e.g., diagnosis, prevention, treatment, or rehabilitation), and were collated into a spreadsheet or word document.

Prioritization stage

Online survey.

The potential topics identified in the first phase were included in online surveys with stakeholders. We first user-tested the survey among the GELA project team to ensure it was readable and understandable. We then invited all identified stakeholders, via email, to complete the survey developed using REDCap [ 30 ]. In Nigeria, the survey invitation was also circulated via WhatsApp to specific stakeholders. In the invitation emails, we also asked stakeholders to forward the email to any colleagues that may have an interest in the topic.

The landing page of the survey provided information about the study’s purpose, that it was a collaboration with the national department/ministries of health, what we were asking participants to do, and a link for more details about the GELA project, after which participants were required to provide consent before they could complete the survey. The survey asked respondents to rate the listed topics according to five criteria (Box 1 ) using a 6-point Likert scale (6—very critical and 1—not important at all) [ 22 , 31 ]. The criteria used were identified through a survey conducted with the GELA research team in which they rated the top five criteria of 22 criteria for priority setting for guidelines identified by El Harakeh et al. [ 32 ]. An explanation for each criterion was provided in the survey. Originally, we had intended that stakeholders would rate each topic according to each criterion, but we asked instead that they consider the five criteria as a whole when rating a topic. We decided that this approach was less onerous for survey respondents and less likely to lead to poor response rates. Topics rated as being of ‘critical importance’ and ‘very critical importance’ were selected for presentation at the consensus meetings with the Steering Group. The first part of the survey also collected demographic information such as type of stakeholders, what they are primarily practicing as and for how many years, the percentage of time spent in patient care, and the type of institution they are primarily based at.

The surveys remained open for 3–4 weeks. Reminder emails were sent to those who were originally invited to participate, once in SA and Malawi, and weekly in Nigeria. As we could not track emails forwarded to others, due to the anonymity setting of the survey, it was not possible to remind those who had been invited in this manner.

Box 1. Criteria used in the priority setting process

Health burden—whether there is a high impact of the health problem/condition in the country as measured by financial cost, mortality, morbidity, or other indicators (e.g. QALYs, DALYs)

Urgency—whether there is an urgent need to address the issue or practice gap

Absence of guidance—whether there are no up-to-date existing guidelines addressing the specific topic and the topic would fit into existing national guideline development processes and priorities

Impact on health outcomes—whether a recommendation on the topic would have a beneficial impact on health outcomes in the country

Feasibility of intervention implementation—whether a guideline/recommendation addressing the topic would be feasible to implement in the national context (i.e. if this is through recognised guideline development bodies

Steering Group consensus meeting

Each country convened a meeting of their Guideline Steering Group to identify the final top three priority topics for guideline development. The number of topics per country was based on the number of recommendations that could be addressed in each country over the broader project period given the resources available. The moderator was a member of the research team and guided the meetings and discussions. This meeting was online in South Africa, and in-person in Malawi and Nigeria. We adopted a modified Nominal Group Technique [ 33 ] to achieve consensus, including five steps:

Step 1: the research team presented a summary of how the topics for the online survey were identified, which included consultation with the same steering group, as well as the results of the survey, including the summary of the topics that were rated as critically and very critically important, which needed further prioritisation.

Step 2: With the help of the moderator the group discussed each topic to ensure that all members understood them in the same way, and we elicited their thoughts on the ratings from the survey.

Step 3: The steering group members were asked to vote, anonymously, on the topics rated as critical or very critical in the survey using a Zoom poll (South Africa) or manually using post-its (Malawi). In Nigeria, the steering group decided to reach consensus through discussion to ensure full ownership of the resulting topics by every member of the group In South Africa only one round of voting was done as the members felt there was sufficient consensus after that. When voting, members ranked the importance of each topic on a six-point Likert scale against the same five criteria used in the online survey.

Step 4: The moderator summarised the results of the voting using bar charts to visualise the rating frequency distribution [ 34 ]. The variations for ratings observed were discussed among the group, including potential explanations before another round of voting, in cases where this took place.

Step 5: Consensus on the top three topics was reached. It was originally anticipated that at the end of this meeting three priority topics—formulated as questions in Population, Intervention, Comparator, and Outcomes (PICO) format—would have been identified for the next stages of the GELA project. However, the topics identified were broad, and further scoping of the literature and existing guidelines were needed to unpack and refine them. Several subsequent meetings with the Steering Groups were therefore needed in each country to present this scoping and finalise the three priority PICO questions per country.

Data management and analysis

Data were exported from the REDCap data management software, cleaned, and analysed using R studio [ 35 ] or STATA 12 [ 36 ]. Simple descriptive statistics were used during the analysis. Median and interquartile ranges (IQRs) were used to rank the topics, which were presented graphically and tabulated in descending order from very critically important to not important at all. Frequencies and proportions were used to describe categorical data. Response rates and missing data were noted. The data were considered as missing at random.

Pre-prioritisation

The members identified and invited to join the Steering Group in each country are described in Table  1 .

Stakeholder mapping identified a range of stakeholders for the survey, including 78 in South Africa, 31 in Malawi, and 40 in Nigeria (Table  2 ). In South Africa, there was greater representation from researchers/academics and health professionals; in Malawi from policymakers and researchers/academics; and in Nigeria from policymakers and professional associations, most of whom were academics.

Initial list of topics

In South Africa and Nigeria, the initial lists of topics identified were very long; over 65 topics, across 14 broad topic areas in South Africa, and 51 topics in Nigeria. Through engagement and input from the respective Steering Group members and other experts—via virtual meetings or email—the lists were narrowed down. The survey in South Africa included 14 topics across six conditions, in Nigeria 27 topics across 10 conditions, and in Malawi 30 topics across eight conditions (Table  3 ). Aside from undernutrition, which was a broad topic included in the surveys of all three countries, there was very little overlap in topics across all the countries. Pneumonia/acute respiratory infection and tuberculosis were common to Malawi and Nigeria, and schistosomiasis was common to South Africa and Malawi.

Prioritisation

All the stakeholders described in Table  2 were invited to complete the online survey via email. In Nigeria, WhatsApp messages were also sent to representatives of professional groups (paediatricians, Obstetricians, neonatologists), who then shared on their groups. The surveys were open for approximately three to four weeks at the end of 2022: 10 October to 8 November in South Africa; 7 to 25 November in Malawi; and 10 November to 3 December in Nigeria. Whereas in South Africa and Malawi fewer people accessed the survey compared to the number of people invited (38/78 in SA, 23/61 in Malawi), in Nigeria a greater number of people accessed it (78/57). However, a similar percentage of those that accessed the survey fully completed it (66% in SA, 70% in Malawi, and 68% in Nigeria). Some respondents completed the first part of the survey, i.e. demographic characteristics, but not the section where they were required to rate the importance of the topics. These respondents were not included in the analysis.

Overall, most respondents were health professionals (81%) and had between 5 and 20 years of experience in practice (63%) (Table  4 ). About a third of participants spent more than 75%, or between 50 and 75%, of their time in direct patient care. Most participants were primarily based at a teaching hospital (41%), and at a hospital (17%) or university (16%).

In SA, nine of 14 topics were rated as critically important , five were rated as very important , and no topic was rated as very critically important (Tables 5 , 6 , 7 ). In Malawi, 10/30 topics were rated as very critically important , 14 as critically important , five as very important , and one as important . In Nigeria, 11/27 topics were rated as very critically important , 13 were rated as critically important , one as very important , one as important and one as not important . The topics that were taken through to the discussion with the Steering Groups included all the critically important topics in South Africa, and all the very critically important topics in Malawi and Nigeria. Individual ratings for each topic included in the survey of each country are presented in the Additional file 1 : Fig. S1–S3.

Some survey respondents suggested additional topics. In South Africa 12/25 people suggested an additional 21 topics, six of 16 respondents in Malawi suggested an additional 15 topics, and 30 of 53 respondents in Nigeria suggested an additional 63 topics. In general, there was little overlap in the additional topics suggested and none were taken up as potential priorities across the countries.

Consensus meeting with Steering Groups

The main consensus meetings were held between November and December 2022 across the three countries. These were attended by members of the SG and research teams in each country. Additional individuals who joined the main Steering Group meetings included observers ( n  = 2), the Malawi and Nigeria project leads ( n  = 2) at the South African meeting, the project coordinator (TK) in Malawi, and a representative from the Department of Health Planning, Research and Statistics in Nigeria.

After the presentation of the results of the online survey (Step 1) and discussion about the top-rated topics (Step 2) (Table  5 ), facilitated by the moderator, the Steering Group members voted to identify the top three topics (Step 3). In South Africa, one round of voting indicated some consensus; of seven people who voted, three topics were rated as critically or very critically important by most people, and three topics were not rated by any member as critical/very critical . After further discussion on the results of the voting (Step 4), four topics were prioritized (Step 5). Figure  3 describes what took place in each step. In Malawi, although 10 top-rated topics were presented, the Steering Group members derived 10 new topics from topic 1 and 9, and these were the topics voted on. Two rounds of voting were done, after which three topics were identified. In Nigeria, the Steering Group agreed to reach decisions on topics by consensus. After extensive deliberations, considering the prevalence of health problems in neonates and the primary causes of these, they decided on four priority topics to consider.

Flow diagram of the steps in the modified Nominal Group Technique

Across all three countries, the topics selected by the end of the consensus meeting were very broad, i.e., each one encompassed many potential questions and was not yet sufficiently specific for a guideline process (i.e., in the Population, Intervention, Comparator, Outcomes—PICO format). Therefore, research teams had to do further work to unpack and refine these. To clarify the PICO questions linked to each topic, the teams compared existing national guidance on prioritised topics with recommendations in relevant WHO guidelines and other global guidance; this allowed identification of gaps in national guidance that the project could address. In Malawi, the team also consulted with experts in the field. This process resulted in seven potential PICO questions in South Africa, six in Malawi, and four in Nigeria. These were presented to the Steering Groups in additional meetings and via email communication, several rounds of which were required before final PICO questions were identified (Table  8 ). The final topics were also discussed with stakeholders responsible for developing and implementing national guidance, to clarify whether they linked to national priorities and whether they could fit within existing guideline development processes and infrastructure. Only topics that fit these conditions were taken through to the next stage of the project, the development of recommendations.

We conducted a priority setting exercise to identify topics and inform new guideline development addressing gaps in newborn and child health in South Africa, Malawi, and Nigeria. In each country, the process included engagements with national Steering Groups comprising representatives of various national-level organisations, multi-stakeholder online surveys, and consensus meetings. At the end of the process three priority PICO questions were identified in each country. In South Africa, the topics concerned anemia prevention in infants and young children through iron supplementation and multiple micronutrient powders, and post-discharge support for caregivers of preterm and LBW babies. In Malawi, they focused on enteral nutrition in critically ill children, diagnosis of childhood cancers in the community, and caring for neonates. In Nigeria, the topics focused on identifying pre-eclampsia in the community, hand hygiene compliance to prevent infections, and enteral nutrition for LBW and preterm infants.

The topics identified are informing the next stages of the GELA project, which include a systematic guideline adaptation process, including scoping existing guidelines or systematic reviews addressing the topics, conducting evidence synthesis where necessary, and convening of guideline panels to make recommendations linked to some or all of the priority PICO questions in the three countries [ 10 ]. Through this process we are aiming to highlight best practice methods for guideline development, including priority setting with the involvement of relevant stakeholders through a transparent and systematic process, and through ensuring the guidelines are developed following rigorous methods and clear and transparent reporting.

The priorities identified at the end of the process had limited overlap across the three countries. This highlights the importance of contextualised priority setting processes, one of the good practice principles of priority setting [ 23 ]. Although contextualised priority setting is important because contextual factors drive the needs and the gaps in healthcare delivery and implementation in different countries, there can also be common priorities and issues. Therefore, countries with similar priorities could draw on existing work at a global or country level, for adaptation into their context, to prevent any regional system fragmentation.

Some of the topics included in the online survey were broad, which made it difficult to identify the questions in required format for a guideline question (PICO) at the end of the main expert consensus meetings. This required substantial work to refine the topics, as well as additional meetings with the Steering Groups, which delayed the finalisation of priority topics and the next steps of the project that depended on priority topics being identified. Ideally, the topics included in the survey should have been more specific. Otherwise, some of the work to clarify the top-rated topics identified through the survey could have been done before the Steering Group consensus meeting, to ensure better efficiency. Future priority setting should also consider more frequent meetings with national Steering Groups advising on topics, given the iterative nature of the process. The process may have been more efficient and easier if the starting point had been a narrower topic area, rather than covering all of newborn and child health.

Although this project aimed to identify priority topics in PICO format that would lead to one recommendation, this may not have been clear to all stakeholders involved. In some cases, stakeholders identified topics that were broad in nature and that would lend themselves for a full guideline encompassing different recommendation. This should be better clarified at the start of the process, when engaging with the stakeholders.

We noted better response rates to the online survey where emails inviting stakeholders to participate in the survey were from a recognised institutional address, and supplemented with WhatsApp communication, a method increasingly recognised as valuable for sharing digital health information [ 37 ].

In some cases, certain Steering Group members tended to dominate the consensus discussions. Management of stakeholder input during these meetings is a critical required skill for successfully gathering everyone’s views. In a study done to prioritise childhood cancer supportive care topics for the development of guidelines, Loeffen and colleagues chose to do a Delphi survey as one of the strengths of this method is the lack of face-to-face meetings to prevent dominant voices being introduced [ 38 ].

Strengths and limitations

We followed a good practice method for priority setting including stakeholder engagement and using an explicit process [ 23 ]. We convened Steering Groups with representatives from relevant national decision-makers to advise on the project and topics, working in close collaboration with Departments of Health, aiming to ensure the project addresses national priorities that could fill a gap in national guidelines and guideline development processes. The online survey facilitated engagement with a broader range of stakeholders, to ensure broad representation of views and perspectives. Furthermore, the guideline development groups that would be identified in the next stage of the project to review the evidence and develop recommendations for each of the identified questions would ensure representation of key stakeholders. We also used specific criteria to rate the importance of topics, which were derived from the literature and which also received input to ensure they were understandable and relevant.

Our study had a few limitations. The response rates to surveys were poor, and could perhaps have been improved if they had remained open for longer. We sent reminder emails to those participants we had invited to complete the survey, but it was not possible to do this for others who may have received the link from others. We did not include patients or carers in the survey; research suggests that their perspectives may differ regarding what treatment decisions are important [ 39 , 40 ]. We did, however, include civil society groups which provided perspectives that consider equity and patient and caregiver perspectives.

Through an explicit process, including stakeholder engagement, reviewing of existing global guidelines and burden of disease, and online surveys we identified three priority questions each in South Africa, Malawi and Nigeria for guidelines addressing newborn and child health. We found that the process was not linear but rather iterative in nature, requiring several engagements with stakeholders to help finalise the topics, as well as managing the conflicting priorities of different groups of stakeholders. Our experience highlights the importance of contextualised priority setting, as shown by the limited overlap in topics prioritised across the three countries, as well as of the relationships with key decisionmakers, who help define the priorities.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Global Evidence Local Adaptation

Non-governmental organisation

Non-profit organisation

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Acknowledgements

Carron Finnan, SAMRC corporate communications for the design of Figs. 1 and 2 .

The members of the steering groups in each country.

This project is funded as part of the EDCTP2 programme supported by the European Union (grant number RIA2020S-3303-GELA). The funder had no role in the design of the study, or in the collection, analysis, and interpretation of data, or in writing the manuscript.

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SD, EEf, NM, MMt, MMc, TK, RC, GK, POV, and SL were involved in the conception and design of the study. SD, EE, MC, DA, EEs, DM, NB, GK, RC were involved with data acquisition or analysis. SD, EE, CN, AB, MMc, MC, DA, EEs, NB, and SL were involved in interpreting the findings. All authors contributed to drafting the manuscript or revising it critically and approved the final manuscript to be published.

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This study has been approved in the three countries in which it is taking place. In South Africa the study was approved by the SAMRC Human Research Ethics Committee on 19 July 2022 (protocol ID EC011-6/2022). In Nigeria, the study was approved by the National Health Research Ethics Committee (Approval Number NHREC/01/01/2007-30/06/2022). In Malawi, the study was approved by the College of Medicine Research and Ethics Committee (COMREC) (number P.06/22/3665).

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Additional file1: figure s1..

Rating of importance of survey topics in South Africa. Figure S2. Rating of importance of Malawi survey topics. Figure S3. Rating of importance of the topics included in the Nigeria survey.

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Durão, S., Effa, E., Mbeye, N. et al. Using a priority setting exercise to identify priorities for guidelines on newborn and child health in South Africa, Malawi, and Nigeria. Health Res Policy Sys 22 , 48 (2024). https://doi.org/10.1186/s12961-024-01133-7

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About 60 percent of nurses with less than two years' work experience are uncomfortable with performing procedures of higher complexity—such as responding to a critical clinical emergency, performing tracheostomy (a surgically created hole in the windpipe) care and suctioning, and chest tube care independently. This requires a lengthened duration of supervision for such procedures in order to ensure the quality of care is never compromised.

The findings were from a study conducted by Singapore General Hospital (SGH), Sengkang General Hospital (SKH), and Singapore Institute of Technology (SIT) to determine how work-ready new nursing graduates are when they join the workforce.

"We wanted to examine how to help best young graduate nurses adjust to their new roles as they transition to the workforce, and this study highlighted the key challenging areas they encountered when they started work," said Dr. Lim Siew Hoon, Nurse Clinician, Division of Nursing, SGH, and corresponding author of the study.

Between November and December 2022, the SGH-led team surveyed more than 450 nurses who joined SingHealth institutions within two years after graduation with either a local diploma or a bachelor's degree.

The findings further showed that more than 40 percent of respondents felt overwhelmed by ethical issues associated with patient care responsibilities, such as when a patient's family's desire conflicts with the required care for the patient. Thirty-seven percent of the nurses surveyed had difficulty managing a dying person.

Twenty-six percent also felt challenged in prioritizing the care needs of multiple patients at any one time, when, for example, a junior nurse has to handle a patient requiring urgent medication and another's call for urgent toilet assistance. Over 20 percent of them also found it challenging to adapt to new technologies and identify data needed specifically for research or quality improvement projects.

Despite these findings, all health care Institutions have a robust competency assessment and training system to ensure new graduates quickly and safely assimilate into their roles. As the findings show, more can be done to enable nurses to transition more smoothly into the workforce after their studies. One way is to look into the training methodology of nurses to help them become more confident practitioners.

The recently launched five-year Bachelor of Science in Nursing—Master of Science in Nursing (BSN-MSN) program is one new opportunity. Developed by the Singapore Institute of Technology (SIT) in collaboration with SingHealth, the BSN-MSN features a through-train approach to equip students with specialized skills that will nurture a new generation of practice-ready nurses who are trained across various clinical settings.

For instance, prospective BSN-MSN students will complete 36 weeks of clinical residency at one of SingHealth's 11 institutions instead of the 32 weeks required by the Singapore Nursing Board. The extra four weeks of residency will allow nursing students to devote more time to clinical practice so that they gain more confidence to perform basic nursing procedures independently after they graduate.

"The BSN-MSN program also focuses on equipping students with practical research and innovation skills. MSN students will be required to work on real-life clinical problems to improve patient care."

"This will provide the students with the opportunity to be intimately involved in the whole research and/or innovation process, thereby honing their methodology capabilities to work on more complex and bigger clinical problems after they graduate," said Adjunct Professor Tracy Carol Ayre, Group Chief Nurse, SingHealth, and the study's senior author.

"I am confident that graduates from this new BSN-MSN program will be better equipped, both in knowledge and practical know-how, to take on the nursing challenges that an aging population will bring," she added.

The study's findings were published in Nurse Education in Practice .

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“Why can’t you help?” Developing research infrastructure in Nigeria

March/april 2024 | volume 23 number 2.

By Susan Scutti

A handful of forthright words spurred Dr. Echezona Ezeanolue to reconsider his career. In 2010, he was a Robert Wood Johnson Health Policy Fellow in the office of Kathleen Sebelius, then U.S. Secretary of Health and Human Services. “They were talking about how, despite all the money spent in Nigeria by the U.S., it was one of four countries where HIV testing among pregnant women was less than 20%. So, the secretary turned to me and said, ‘You're from Nigeria—why can't you help?’”

At that time Ezeanolue’s appointment was at the University of Nevada, Las Vegas and all his research was U.S.-based. Yet he left Sibelius’ office determined to work in Nigeria. Soon after, he applied for and received a grant jointly funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Fogarty and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) studying mother-to-child HIV transmission.

“I went back to Nigeria, and saw Harvard was there, University of Maryland was there, Vanderbilt was there—many U. S. institutions were there. So, I thought, This isn’t a problem of expertise, but one of culture .” He called all of them and asked, What’s the issue? “They told me they couldn’t find pregnant women.” He smiled ruefully as he recalled thinking, How can you not find pregnant women?  Turns out, they’d set up their programs in health institutions as they would do in the U.S. Yet, unlike the U.S., only about a third of Nigerian women deliver in health facilities. The number of women willing to participate in each program was insufficient for creating study cohorts.

Community orientation

To work with women on their own terms, Ezeanolue started a community-based intervention in 40 neighborhoods and villages. He decided to offer additional services since he knew HIV/AIDS was highly stigmatized. This way, he’d attract more participants. “We called the pregnant women and asked them what else could we offer them. The first thing they mentioned was nutrition during pregnancy, what could they eat if they couldn’t afford multivitamins?” (Ripe plantains can provide iron during pregnancy.) 

“The second thing [the mothers asked about] was sickle cell checkups,” said Ezeanolue, noting Nigeria has the highest number of people in the world born with sickle cell disease. “Then we asked the men what they wanted, since they drive the women to (and pay for) health care.” The men wanted anemia check-ups. “So we added hemoglobin testing. And, in Nigeria, the number one cause of disability is stroke from undiagnosed and uncontrolled hypertension, so we added blood pressure to our list. Finally, we included depression screening.”

Ezeanolue’s first project in Nigeria yielded 25 publications. “We had data on HIV, anemia, sickle cell, hypertension, and depression. We found out 35% of the people diagnosed with hypertension didn't even know they had hypertension.” Since that project, he’s acquired an additional role at University of Nigeria Nsukka (UNN) and conducted several NIH-funded studies in Nigeria, including Strengthening Research Administration Infrastructure for HIV Research , a Fogarty G-11 project that is still underway.

Laying the groundwork for research infrastructure

One of the world’s largest HIV epidemics exists in Nigeria; 1.8 million people there live with HIV. The U.S. government has made substantial investments in HIV care and research in Nigeria, and UNN College of Medicine has implemented multiple projects, but only as a sub-awardee. While 93% of researchers at UNN expressed interest in submitting grant applications, only 28% knew where to get research administration support, a needs assessment found. Ezeanolue’s project, a partnership between UNN and University of California, San Diego (UCSD), aims to further develop, professionalize, and reinforce research administration and management infrastructure at UNN so that it can become a primary grant recipient.

Dr. Gregory Aarons, a professor at UCSD, is a principal investigator (PI) on this G-11 project. “I was doing training on implementation science for Fogarty in sub-Saharan Africa and I got to meet many researchers, including Eche Ezeanolue,” recalled Aarons.    (Ezeanolue made the most of this first encounter, immediately asking Aarons to work with him on the “ baby shower initiative ,” a study evaluating delivery of HIV services at churches.)   “I became very interested in Eche’s community-based research approach for implementing HIV prevention and treatment for pregnant women.”

Ezeanolue developed his singular research approach following a network meeting organized by Fogarty’s Dr. Rachel Sturke and NICHD’s Dr. George Siberry. Sturke and Siberry had asked the HIV investigators a meeting in South Africa to bring along one of their collaborators; Ezeanolue arrived with a church bishop and Nigeria’s CDC director. “When I saw how that meeting was organized—how it was a platform to share—I recognized that there’s a gap in Nigeria,” said Ezeanolue. In his experience, Nigerian scientists had to go outside the country to learn what’s happening inside the country. Returning to Nigeria, he immediately called all the PEPFAR-funded investigators there to discuss forming a platform—an alliance for implementation research.

NISA, an engine for growth

The Nigerian Implementation Science Alliance (NISA) has three main focuses, he explained. First, NISA develops infrastructure to conduct clinical trials and implementation science. Second, it builds a cadre of well-educated research staff. Third, NISA brings together investigators, policymakers, NGO staff, and others to share ideas and learn what researchers have already done, so they can avoid repeating what hadn’t worked, while adopting and scaling up what had.

“We decided not to ask NIH for funding because we wanted to build something sustainable,” he said. “That made everybody laugh.” Seemingly, only Sturke and Siberry took him seriously. “They promised to support us informally (since we weren’t funded by them), and we organized our first meeting in 2015. Both came and that was the start of NISA.”

Today, NISA rests on four pillars: weekly research-in-progress meetings; monthly webinars; quarterly research sharing weeks; and a yearly conference. Aarons, a NISA conference keynote speaker over multiple yeas, said, “I was really impressed with the ability of Eche and the UNN team to bring people from across Nigeria and other West African countries to NISA, where people could learn about implementation science and how it can accelerate adoption of evidence-based treatments and prevention approaches.” Aarons also saw how the first-of-its-kind practice-based research network developed from NISA could build on the G-11-funded program in developing research capacity.

Ezeanolue explained, “We selected two sites from each of the country’s six regions and made them what we call ‘implementation laboratories.’ If we implement something in two sites in every region and it works, then each of those sites will become model innovation centers to help scale-up regionally.” Ezeanolue is director of UNN’s Center for Translation and Implementation Science (CTAIR) , the network’s organizing hub. His and Aaron’s G-11 grant, then, aims to strengthen the research administration infrastructure of UNN and CTAIR.

The grant requires training 12 people in research administration. Aarons said, “We cast a wide net to look for who was really poised to be in those administration roles. We didn't want to train people if they weren't going to actually go back and practice.” Then they brought in an additional 12 people, doubling the number of trainees. "Remember the 12 network sites, two in each region?” Ezeanolue asked. “We’re also training one community research engagement officer from each of those sites. These are the people who go to the church, the mosque, the community, and talk about the research we're about to do, why it's important and why people should participate.”

Focus: Fogarty’s G-11 program builds support infrastructure

• Building infrastructure so scientists can focus on research
• Fortifying research ethics at Kinshasa University
• Developing research infrastructure in Nigeria

Integrating administration and research training

Nicole Joyce, a UCSD research administrator, had never met Aarons before receiving an email from him in 2020, requesting information about her program. “In our first meeting, it slowly dawned on me that he didn’t want to just send staff to my training—he was asking me to co-develop a capacity building program with UNN.” She immediately felt intimidated. “Administrators don’t cross over to the research side very often.” However, Joyce’s infectious enthusiasm for research administration was clear to Aarons, who believed this could be a great opportunity for her to make a difference in global health.

Joyce’s training strategy is anchored to the research administration life cycle: “So we look pre-award activities, post-award activities, compliance activities, and the systems, tools and resources researchers need to perform those activities.” Though Joyce began her UNN training in the usual way, she quickly learned to adapt to the realities of Nigeria’s infrastructure. “They commonly have power outages and unreliable Internet. Some trainees didn't have laptops, software, or tech skills.” When they trained on-site in Enugu, Nigeria, the team encountered unexpected hurdles when SAM (the U.S. government system for awards management) couldn’t “talk to” another system. “A little technical challenge around an address character limitation ended up costing us nine months and not being able to pay a sub-awardee.”

Nevertheless, the team scored undeniable triumphs. Notably, a National Cancer Institute research grant awarded to Aarons and Ezeanolue alongside the G-11 project helped provide the trainees with much needed real-world experience. Aarons said, “We're developing a sense of collaboration. The administrators feel they're part of something important… because they are.   ”Hands-on coaching and mentoring continue during the project’s second year via weekly, sometimes daily calls." He added, “Through everyone's enthusiasm, it’s going way beyond what we proposed—it’s building not just UNN’s infrastructure but a nation's infrastructure.”

More Information

• Related Fogarty grant: Strengthening Research Administration Infrastructure for HIV Research in Nigeria
• Echezona Ezeanolue, MD, MPH, biography via Center for Translation and Implementation Science (CTAIR)
• Greg Aarons, PhD, biography via the  University of California San Diego
• Profile of Nicole Joyce, MBA , director of sponsored research administration, Business Intelligence Systems and Innovation Strategies at UCSD
• The baby shower initiative , Annals of Global Health , September 25, 2014

Updated April 16, 2024

To view Adobe PDF files, download current, free accessible plug-ins from Adobe's website .

Related Fogarty Programs

• Fogarty HIV Research Training

Related World Regions / Countries

• Sub-Saharan Africa

Related Global Health Research Topics

• Mentoring and mentorship training

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The Nigerian health care system: Need for integrating adequate medical intelligence and surveillance systems

Menizibeya osain welcome.

Department of Normal Physiology, Belarusian State Medical University, Minsk, Belarus, Pr., Dzerjinsky 83, Minsk, Belarus

Objectives:

As an important element of national security, public health not only functions to provide adequate and timely medical care but also track, monitor, and control disease outbreak. The Nigerian health care had suffered several infectious disease outbreaks year after year. Hence, there is need to tackle the problem. This study aims to review the state of the Nigerian health care system and to provide possible recommendations to the worsening state of health care in the country. To give up-to-date recommendations for the Nigerian health care system, this study also aims at reviewing the dynamics of health care in the United States, Britain, and Europe with regards to methods of medical intelligence/surveillance.

Materials and Methods:

Databases were searched for relevant literatures using the following keywords: Nigerian health care, Nigerian health care system, and Nigerian primary health care system. Additional keywords used in the search were as follows: United States (OR Europe) health care dynamics, Medical Intelligence, Medical Intelligence systems, Public health surveillance systems, Nigerian medical intelligence, Nigerian surveillance systems, and Nigerian health information system. Literatures were searched in scientific databases Pubmed and African Journals OnLine. Internet searches were based on Google and Search Nigeria.

Medical intelligence and surveillance represent a very useful component in the health care system and control diseases outbreak, bioattack, etc. There is increasing role of automated-based medical intelligence and surveillance systems, in addition to the traditional manual pattern of document retrieval in advanced medical setting such as those in western and European countries.

Conclusion:

The Nigerian health care system is poorly developed. No adequate and functional surveillance systems are developed. To achieve success in health care in this modern era, a system well grounded in routine surveillance and medical intelligence as the backbone of the health sector is necessary, besides adequate management couple with strong leadership principles.

The Nigerian health care has suffered several down-falls.[ 1 – 7 ] Despite Nigerian's strategic position in Africa, the country is greatly underserved in the health care sphere. Health facilities (health centers, personnel, and medical equipments) are inadequate in this country, especially in rural areas.[ 1 , 2 , 6 ] While various reforms have been put forward by the Nigerian government to address the wide ranging issues in the health care system, they are yet to be implemented at the state and local government area levels.[ 3 , 6 ] According to the 2009 communiquι of the Nigerian national health conference, health care system remains weak as evidenced by lack of coordination, fragmentation of services, dearth of resources, including drug and supplies, inadequate and decaying infrastructure, inequity in resource distribution, and access to care and very deplorable quality of care. The communiquι further outlined the lack of clarity of roles and responsibilities among the different levels of government to have compounded the situation.[ 3 ]

Unarguably, problems in the health care system of any country abound to a certain extent.[ 8 – 11 ] Although health has the potential to attract considerable political attention, the amount of attention it actually receives varies from place to place. In their commentary of the 3T's road map to transform US health care, Denise Dougherty and Patrick H. Conway rightly stated a step by step transformation of the US health care system from 1T →2T →3T which is required to create and sustain an information-rich and patient-focused health care system that reliably delivers high-quality care.[ 8 ]

Provision of timely information aimed at combating possible health menace among many other things is an important function of public health. Hence, inadequate tracking techniques in the public health sector can lead to huge health insecurity, and hence endanger national security, etc.[ 11 – 16 ]

For decades ago, communicable diseases outbreak was a threat not only to lives of individuals but also national security. Today it is possible to track outbreaks of diseases and step up medical treatment and preventive measures even before it spreads over a large populace.[ 17 – 20 ] Medical and epidemiological surveillance, besides adequate health care delivery, are essential functions of public health agencies whose mandate is to protect the public from major health threats, including communicable diseases outbreak, disaster outbreak, and bioterrorism.[ 17 – 20 ] To avoid the various threats and communication lapses to strengthen the health work force planning, management, and training which can have a positive effect on the health sector performance, one requires timely and accurate medical information from a wide range of sources.[ 12 ]

The Nigerian health care had suffered several infectious disease outbreaks and mass chemical poisoning for several years. Hence, there is immense need to tackle the problem.[ 1 – 6 , 21 – 24 ]

This study aims to review the state of the Nigerian health care system and to provide possible recommendations/solutions to the worsening state of health care in the country. To give up-to-date recommendations for the Nigerian health care system, the dynamics of health care in the United States and Europe with regards to methods of medical intelligence and surveillance (MIS) are also reviewed. In this article, MIS systems are suggested to be integrated into Nigerian health care system to serve the needs the health care system of the modern era.

Materials and Methods

Search strategy.

Search for literatures for this review was conducted throughout the period of the study to track new developments and published reports and articles. The search period was from June 2010 to January 2011. This study adopted a qualitative approach, so as to adequately describe the study aims and objectives. The study was based on both primary and secondary data. The primary data for this study were collected through scientific database sources and web engine searches. Secondary data were based on direct observation and relevant documents from the Nigerian Ministry of Health.

Sources of literatures

• Scientific databases: the following databases were included in the search process—PubMed and African Journals Online.
• Internet searches were based on Google and Search Nigeria ( http://www.searchnigeria.net ).

Search design

Searches in peer-reviewed databases, Google, and Search Nigeria were conducted in the following phases [ Table 1 ]. Once a preliminary list of articles was determined, the databases and Google were researched for additional articles/reports once a month to constantly track new reports and articles. Using an analytical and ancestry approach, the articles chosen were scanned for further relevant articles. The following techniques[ 25 ] were applied to further retrieve relevant articles for the review process.

Number of literatures/web page documents in various searches

Backward references search: The references of high-quality articles were searched to retrieve important information about the state of the Nigerian health care system.

Forward references search: Reviewing additional articles that have cited the article/report to locate follow-up studies or newer developments related to the state of the Nigerian health care system.

The backward and forward searches were terminated when no new idea was found. The reference list represents part of the literatures retrieved during the data collection process.

Keyword search parameters

This study was limited to keyword searches that resulted in the most relevant results. A keyword combination search was used since in this way the study aims and objectives are better attained. The following keyword combinations were used in all cases of the literature searches. The keyword searches were performed in three phases:

First phase keyword search

Nigerian health care, Nigerian health care system, and Nigerian primary health care system.

Second phase keyword search

Additional keywords used in the search were United States (OR Europe) health care dynamics. This additional search was performed to ensure an up-to-date review and recommendations for the Nigerian health care system and was not meant to review health care in the United States, Britain, or Europe with regards to methods of medical intelligence/surveillance. Some of the literatures retrieved in this search phase are listed in the reference list.[ 8 – 10 , 26 – 38 ]

Third phase keyword search

This third phase literature search was necessarily based on the retrieved results of the second phase backward reference searches. The third phase keywords combination included the following: Medical Intelligence, Medical Intelligence systems, Public health surveillance systems, Nigerian medical intelligence, Nigerian surveillance systems, and Nigerian health information system.

Backward and forward reference searches were carried out in all phases of the keyword search.

Literature selection process

Inclusion criteria.

Original communications, review articles, reports, and web page documents that report on the aim of this study were included for the review process. The articles were selected based on their relevance to the topic of this study. The results of searches were filtered according to their relevance to the aim of this search. The tittles that were logged in the various databases searched were analyzed against the keyword terms. Reports not wholly focused on the topic of this study were not included for review. All the retrieved publications were reviewed with emphasis on the state/dynamics of the Nigerian health care system, role of medical intelligence/surveillance systems in the health care system.

• This study included literatures that meant the following criteria:
• Literatures that meant the parameters of the keyword search.

Studies that discuss the history and state/dynamics of the Nigerian health care system; flaws of the Nigerian health care; managerial/information technological aspect of the Nigerian health care system; and medical intelligence/surveillance system in the Nigerian as well as other countries’ health care system.

Data analysis and synthesis

Data were extracted and recorded in Excel and Word 2007. The statistical value for significance was set at P < 0.05. Studies were analyzed based on its relevance to the Nigeria health care system.

Results and Discussion

The provision of health care in Nigeria remains the functions of the three tiers of government: the federal, state, and local government.[ 39 – 41 ] The primary health care system is managed by the 774 local government areas (LGAs), with support from their respective state ministries of health as well as private medical practitioners.[ 40 ] The primary health care has its sublevel at the village, district, and LGA. The secondary health care system is managed by the ministry of health at the state level. Patients at this level are often referred from the primary health care. This is the first level of specialty services and is available at different divisions of the state. The state primary health care comprises laboratory and diagnostic services, rehabilitation, etc. The tertiary primary health care is provided by teaching hospitals and specialist hospitals. At this level, the federal government also works with voluntary and nongovernmental organizations, as well as private practitioners.[ 39 , 42 – 44 ]

Health care reforms launched in Nigeria

Ten-year developmental plan.

Before independence in 1960, a 10-year developmental plan (1946–1956) was introduced to enhance health care delivery. Several health schools and institutions (Ministry of Health, several clinics and health centers) were developed according to this plan. By the 1980s, there had been great development in health care—general hospitals and several other health centers (over 10,000) had been introduced.[ 42 , 43 ]

The primary health care plan

August 1987, the federal government launched its primary health care plan with the following major objectives:[ 12 , 42 , 43 ]

• Improve collection and monitoring of health data
• Improve personnel development in the health care
• Ensure the provision essential drug availability
• Improve on immunization programs
• Promote treatment of epidemic diseases
• Improve food supply and nutrition
• Improve material and child care, and family planning
• Educate people on prevailing health problems and the methods of preventing and controlling them.

This health care plan made little impact on the health sector, as it continued to suffer major infrastructural, and personnel deficit, in addition to poor public health management.

Nigerian health insurance scheme

As an effort by the federal government to revitalize the worsening state of health, the Nigerian health insurance scheme (NHIS) that was established in 2005 by Decree 35 of 1999 provided for the establishment of a governing council with the responsibility of managing the scheme.[ 41 ] However, Ladi Awosika noted that the scheme was first proposed in 1962 under a bill to parliament by the then Minister for Health.[ 43 ]

The objectives of the scheme were to[ 41 , 45 ]

• Ensure that every Nigerian has access to good health care services
• Protect Nigerians from the financial burden of medical bills
• Limit the rise in the cost of health care services
• Ensure efficiency in health care services
• Ensure equitable distribution of health care costs among different income groups; equitable patronage of all levels of health care
• Maintain high standard of health care delivery services within the scheme
• Improve and harness private sector participation in the provision of health care services
• Ensure adequate distribution of health facilities within the Federation
• Ensure the availability of funds to the health sector for improved services.

The objectives and functions of the NHIS[ 44 , 45 ] according to this present review have hardly attained any height as health care delivery continues to be limited; not equitable and does not meet the needs of the majority of the Nigerian people. This is indicative of the high infant mortality rate/poor maternal care, very low life expectancy as at 2010, and periodical outbreak of the same disease, as well as the long period of time spent for control of the various outbreaks [Tables ​ [Tables2 2 and ​ and3 3 ].

Some health indicators for Nigeria[ 12 ]

Disease outbreak and chemical disaster in Nigeria between 2006 and 2010[ 48 ]

The appendage program of the NHIS launched in October 2008—Millennium Development Goals—also reported little positive effect a year later. The Nigerian National Health Conference in 2006 which was attended by more than 400 participants, including high cadre dignitaries ranging from the presidency to local governments and their agencies were aimed at ensuring effective, qualitative, affordable, and accessible health care for all Nigerians beyond 2007.[ 3 – 6 ] According to the 2005 January issue of CARE-NET limited health insurance report concerning the NHIS, the Nigerian national health policy objective was the attainment of a level of health that will enable all Nigerians to achieve socially and economically productive lives.[ 46 ] Since its lunching primary health care has not gained its right place in the priority of things.[ 3 – 6 , 46 ] As part of the struggle to advance health care, the Nigerian senate in 2008 launched a bill for an act to provide a framework for the regulation, development, and management of a national health system and set standards for rendering health services in the federation and other matters connected with it.[ 45 ]

In spite of the several failures of the Nigerian health care system, recent study had suggested that if managed well, the NHIS could be a useful ground for good health care delivery.[ 47 ] At its present state, it is true that the scheme does not adequately account for the needs of the Nigerian people.

Indicators of health care in Nigeria

In spite of the huge development in the health care in relation to the last decades,[ 12 , 42 – 44 ] much is still needed to be done in the health care system.[ 39 , 40 ] This is evident in the various health indicators outlined in Table 2 and mortality from several outbreaks of diseases in Table 3 .[ 48 ]

Although the total expenditure in health amounts to 4.6% GDP,[ 12 ] financial managerial competency, besides inadequate funding, remains a major problem. Current statistics show that health institutions rendering health care in Nigeria are 33,303 general hospitals, 20,278 primary health centers and posts, and 59 teaching hospital and federal medical centers.[ 40 ] This represents a huge improvement in regards to the last decades; nonetheless, health care institution continues to suffer shortage.

The backward and forward reference searches on second phase keywords search revealed increasing role of health information, communication as integral to leadership,[ 8 – 11 , 18 – 20 , 26 – 38 ] as well as increasing role of medical intelligence/surveillance in the health care system in the United States and Europe.[ 12 , 49 , 50 – 83 ]

Health care dynamics in the United States and Europe with regards to methods of medical intelligence/surveillance

Literature data report on the huge developments of MIS systems in Europe and most especially in the United States in the last few decades. For instance, the MedISys is adapted and used by 11 national public health of Europe and 4 supranatural organizations, including World Health Organization and Euro-Surveillance. MedISys provides opportunity to monitor issues of health concerns to registered countries and organizations.[ 49 , 72 , 75 , 82 ] MIS has often been used in both military health care departments[ 70 ] and public health sector.[ 73 ] MIS systems have been used to combat and effectively monitor the outbreak of communicable diseases, bioattack. etc.[ 61 , 73 ] Indeed, MIS systems were crucial to controlling SARS in 2003 and eradication of small pox in the 1970s.[ 61 ] Some MIS systems used today are listed in Table 3 . Other monitoring systems in the health care setting are the Global Monitor and HealthMap.[ 49 , 72 , 83 ]

Based on the analysis[ 7 , 18 – 20 , 72 , 82 , 50 – 85 ] of this study, MIS systems could be divided into three broad categories:

• Manual-based medical MIS systems. A huge disadvantage of method of MIS: difficult to manage, poor access, data are not easily presentable, data processing is time–consuming, and large space storage space needed.
• Automated-based medical MIS systems. Although this method of data processing has its peculiar shortcomings, the advantages exceed its disadvantages: data collection, aggregation, storing and analysis, sharing, and transmission is by hundreds of times faster and easier.
• Integrated manual-web based MIS systems (use both manual data search and web-mining).

MIS match searched results against taxonomy of named entities, e.g., names of infectious diseases, countries, or cities. Using specialized principle (e.g., ontology principle), terms/words are organized into synonyms, symptoms, associated syndromes and hosts, etc.[ 49 , 72 , 76 – 82 ] A combination of at least two MIS systems has always provided for a higher tracking precision. For example, analysis of documents by PULS, previously identified by MedISys, improves precision by almost 100%, although economically expensive.[ 72 ] However, a major disadvantage of the MedISys and PULS is their inability to perform deeper analysis of critical issues of public health concerns which is a major disadvantage.[ 72 ] Hence, integrated manual web-based medical intelligence/surveillance with professional analysis in the field provides a greater advantage over other methods of MIS (an example of such a model in shown in Figure 1 ).

A model of medical intelligence/surveillance

One of the most advanced MIS systems used today is the BioWatch which is presently installed in 30 US cities to constantly monitor biothreats.[ 67 ] The biowatch system consists of airfilter that collects air sample for genetic analysis of any bioweapon of specific interest. Targeted nucleic acid sequence associated with a pathogenetic agent is screened for in specialized laboratory. A positive result meant that the pathogenetic agent of specific interest is present in the air.[ 67 – 73 ] It is, however, pertinent to note that the present second-generation biowatch system carry a huge disadvantage as air filtered are not automatically analyzed by the system. Manual collection of filtered air sample for laboratory test has to be carried out before obtaining results. The next-generation BioWatch is presently been developed to solve this problem.[ 67 ] Several other MIS systems[ 73 ] work by syndromic approach and by analyzing signs and symptoms of diseases based on respiratory, gastrointestinal, hemorrhagic illness, etc. [ Table 4 ].

Medical intelligence/surveillance systems and their country of usage[ 73 ]

A major disadvantage that could be noted in all MIS systems is the detection of already present disaster (although the early detection allows for a faster action/control of the disaster). At this point, there could have been several fatal cases.[ 67 , 72 , 73 , 79 , 83 ] To avoid this, the present-day MIS systems integrate their functions with the evaluation of risk. That means public health disaster can be tracked even before it affects a wide population of people. One example of MIS risk system is the Brief Spousal Assault Form for the Evaluation of Risk.[ 73 ]

Major flaws in the Nigerian health care system

In spite of the various reforms to increase the provision of health to the Nigerian people, health access is only 43.3%.[ 5 ] The inadequacy of the health care delivery system in Nigeria could be attributed to the peculiar demographics of the Nigerian populace. About 55% of the population lives in the rural areas and only ~45% live in the urban areas.[ 40 , 49 ] About 70% of the health care is provided by private vendors and only 30% by the government.[ 40 , 86 – 91 ] Over 70% of drugs dispensed are substandard. Hence, the ineffectiveness of the NIHS had recently been attributed to the fact that the scheme represents only 40% of the entire population, and 52-60% are employed in the informal sector.

Over half of the population live below the poverty line, on less than $1 a day and so cannot afford the high cost of health care.[ 49 ] Also, a recent study by Akande had reported a poor referral system between the various tiers of health care which probably tells on the poor managerial functions of the health care delivery system.[ 84 ]

At the primary health care level, some have sort solutions to the aforementioned flaws. For example, several community health financing schemes [Community Based Health Insurance (CBHI)] from individuals’ (taxi drivers, market women, etc.) effort to provide the health needs for their communities are documented.[ 5 , 84 ] Some urban subpopulations have also initiated the scheme. The number of CBHI probably exceeds 585 according to a recent report by Obinna Onwujekwe and colleagues (2010).[ 5 ] In that study, the authors reported high preferences for health care benefits both at the urban and rural areas [ Table 5 ]. Problems encountered in the CBHI are its very small and inadequate funding capabilities. That notwithstanding, some CBHI have increased their scope to be registered as health maintenance organizations.[ 5 ] Also, quality of health care provided is not accessed, although this remains a problem for the NHIS too.

Preferences for health care packages as reported by majority of people

While several studies have reported many aspects of the Nigerian health care system, no work has been done in the aspect of disease tracking, and MIS techniques to meet the need of the Nigerian populace in the modern era; practically, no attention is given to surveillance systems. Hence, a major shortcoming of the Nigerian health care system is the absence of adequate MIS systems to track disease outbreaks, mass chemical poisoning, etc.

The way forward for the Nigerian health care system/recommendations

Several flaws in the health care system could have been averted through adequate MIS, which is supposed to be the first line of approach to developing the Nigerian health care system. Of course, there is a long list of barriers which lie on the pattern of leadership, infrastructures, man power challenges, clinical training, standardized diagnostic instruments, etc.[ 7 , 12 , 1 – 6 , 21 – 24 , 86 , 91 – 95 ] The reforms and changes made to retain health security seem not to have made positive effect on the health care system.[ 1 , 3 , 45 , 46 ] Considering the threats of health insecurity,[ 86 ] there is therefore immense need to revitalize the Nigerian health care system and provide specific project design to enhance cooperation and efficiency. To account for the modern day needs of Nigerians, the health care delivery system must adequately meet the following functions:

• Effectively assess patients’ dilapidating state of health
• Refer patients to specialists for appropriate treatments and supportive services
• Recognize, treat, or refer comorbid medical and psychiatric conditions for specialists’ treatment
• Perform age, gender, and culturally appropriate disease screening
• Provide brief interventions to patients with dilapidating state of health
• Chronic diseases management and prevention
• Family planning to be cooperated effectively into the health care delivery system
• Systematically and routinely measure the quality of services provided by the health system
• Mortality data of specific project enrollees to measure the effectiveness of health care provided
• Carry out health campaigns and awareness
• Develop effective counseling methods
• Comparative analysis with other countries’ experiences in addressing health changes
• Calculate the economic gain or loss of health care provided
• Economic distribution of services with adequate capitation rate
• Verify delivery of health services
• Provide performance based incentives on a regular basis
• Strong knowledge base/research culture

The huge problems encountered by the Nigerian health care system[ 1 – 7 , 12 , 21 – 24 , 45 , 46 , 86 , 91 – 95 ] could partly be due to the absence of MIS system which holds the key to successful medical leadership, as well as health care delivery. Hence, there is necessity to setup a model of MIS systems for action to suit the interest of the Nigerian people. It is supposed that if adequately managed, MIS system model for the Nigerian health care will turn out to be the Cinderella of Nigerian health care system. A view of the model is shown in Figure 1 .

The model not only specifically addresses the present problem but also put into consideration modern MIS techniques; it solves the problems encountered in several other models by adding a deeper professional analysis. Besides, it is multifunctional.

The model will perform the same functions as other MIS systems[ 62 , 75 ] do text mining from a variety of sources and track bioterrorism (such as airport biothreat, etc.), diseases (contagious, sexually transmitted diseases. etc.), events etc. The central system will analyze current result of reports and internet data received against keyword entities and to undergo selective processing of results. By selective processing, the system sends information, where appropriate to local points, government organizations, and intelligence; perform professionalized and deeper analysis of critical information or search results of critical importance will be sent for a deeper professional analysis. The model for MIS will match searched/received results against taxonomy of named entities, names of infectious diseases, states, local governments or cities/towns, villages, health agencies, etc. Besides its basic functions, it will file-out reports, send requests, issue alerts, perform several system commands, and have several databases access. Also, it will track progression and capture ongoing events, and brief situation and dynamics of events to others by selective processing. The proposed model for MIS will be suited for the Nigerian interest. To optimized information, the system will be linked to other international monitoring systems to effectively manage and control outbreaks of communicable diseases and bioterrorism threats.

The Nigerian health care system is poorly developed and has suffered several backdrops, especially at the Local Government Levels. No adequate and functional surveillance systems are developed and hence no tracking system to monitor the outbreak of communicable diseases, bioterrorism, chemical poisoning, etc. To achieve success in health care in this modern era, a system well grounded in routine surveillance and medical intelligence as the backbone of the health sector is necessary, besides adequate management couple with strong leadership principles. The recommendations given in this study may as well be applicable to other countries (especially African countries, such as Niger) that suffer the same problem.

Source of Support: Nil.

Conflict of Interest: None declared.