ARTICLES FOR PRESENTATION AT ACEDCAMDS BY THE CASHVILLE GROUP OF COMPANIES AND PARTNERS LED BY DR...

(A.) ASSESSMENT OF PREVALENCE OF CATEGORIES OF TREATMENT

OF PRIVATE MIX TUBERCULOSIS CONTROL PROGRAMME IN

SOUTHEASTERN NIGERIA

ABSTRACT:

The Federal Ministry of Health of Nigeria for tuberculosis(TB) control programme

recommended for standardization two categories of Directly Observed Therapy Short

course(DOTS). The materials and methods utilized were a descriptive retrospective cohort study

design to analyze secondary data set (2007-2010) of patients accessing prevalence categories of

TB-DOTS treatment and outcomes in two comparable private facilities (Immaculate Heart of

Catholic Church Hospital,IHCCH and Diocesan Anglican Communion Hospital,DACH ) in

Anambra State, Nigeria. The results showed different cured , defaulter, interrupted, death and

failure rates outcomes with different categories of treatment for different period of years for the

two different hospitals. Conclusively, Diocesan Anglican Communion Hospital has higher

chances of Multiple Drug Resistant TB patients compared to Immaculate Heart Catholic Church

Hospital .

Efegbere HA 1,5 , Iortyom TS5, Efegbere EK 5 , Evans R5 , Idowu M5, Joshua A5 , Oyakilome MI

5, Ojo I5, Akpona F5 , Afiadigwe EE 2 , Anyabolu AE 3 , Enemuo HE3, Adogu PO1, Ebenebe EU

1 , Onyeyili AN4, Ezejiofor OI3, Onyeyili AN 4 , Sani-Gwarzo N 5,6 , Omoniyi A 5,6 , Ilika LI 1 ,

Igwegbe AO 7, Oyeka CE 8 , Ofili AN 9 , Asuzu MC 10 , Onajole TA 11

1. Department of Community Medicine, Nnamdi Azikiwe University Teaching Hospital ,

Nnewi, Anambra State, Nigeria.

2. Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi,

Anambra State, Nigeria.

3. Department of Internal Medicine, Nnamdi Azikiwe University Teaching Hospital,


4. Department of Nursing Services, Nnamdi Azikiwe University Teaching Hospital,


5. Cashville Group of Companies and Partners, worldwide(25 inter-dependent firms).

6. Federal Ministry of Health, Abuja, Nigeria.

7. Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching

Hospital, Nnewi, Anambra State, Nigeria.

8. Department of Statistics, Nnamdi Azikiwe University, Awka Campus, P.M.B. 5001,

Awka , Anambra State, Nigeria.

9. Department of Community Medicine, University of Benin Teaching Hospital, Benin

City, Edo State, Nigeria.

10. Department of Community Medicine, University College Hospital, Ibadan, Oyo State,

Nigeria.

11. Department of Community Medicine and Primary Health, Lagos University Teaching

Hospital, Lagos State, Nigeria.

Name and address of the corresponding authour: Henry A. Efegbere 1, 5

Email of the corresponding author: [email protected]

Mobile of the corresponding author : +2348035984104

Source of Support- Nil.

Conflict of Interest-None declared.

Copyright: Unpublished

Key words: Pulmonary Tuberculosis, Treatment Category, Treatments Outcomes,

mailto:[email protected]

Private Mix

Introduction: WHO grouped patients receiving anti-tuberculosis Directly Observed Therapy

Short course according to the three major treatment categories described by Treatment regimens

administered, however, this study used the standardization of two categories according to the

Federal Ministry of Health of Nigeria.

Materials and Methods: A descriptive retrospective cohort study design used to analyze

secondary data set (2007-2010) of patients accessing prevalence categories of TB-DOTS

treatment and outcomes in two comparable private facilities (Immaculate Heart of Catholic

Church Hospital, IHCCH and Diocesan Anglican Communion Hospital, DACH ) in Nnewi

North Local Government Area, Anambra State, Nigeria.

Results: In IHCCH (Immaculate Heart of Catholic Church Hospital), 43.7% of cured rate

outcomes received only category 1 of treatment; 1.4% of failure rate outcome received only

category 2 of treatment. In DACH(Diocesan Anglican Communion Hospital), 60.4% of cured

rate outcome received category 1 of treatment while 2.1% of that outcome received category 2 of

treatment; no failure rate outcome recorded.

IHCCH had 93.0% of category 1 of treatment with 7.0% of category 2 of treatment; DACH had

95.8% of category 1 of treatment with 4.2% of category 2 of treatment.

Conclusion and Recommendations: Diocesan Anglican Communion Hospital (DACH) has

more chances of Multiple Drug Resistant TB patients compared to Immaculate Heart Catholic

Church Hospital (IHCCH). Therefore, its recommended that in order to eliminate the prevalence

of Multiple Drug Resistant Tuberculosis adequate Gene Expert diagnostics matched with enough

proficient health professionals be made nationally accessible at all levels of health care delivery

that undertake DOTS services. Also, future research to juxtapose findings against WHO

standards for internationalization of local findings. Furthermore, research is to analyse primary

data set for Tuberculosis epidemiological profiling and comprehensiveness.

Acknowledgements: Professors Ibeh CC, Ikechebelu J, Asuzu MC, Onayade A , Onajole TA,

Ofili AN, Okojie E; Drs. Fagbemi I, Omoniyi A (FMoH), Obi-Okaro ,Adinma ED,

Emelumadu, I Modebe, Nwanbueze AN, Ubajaka C, Udigwe I, Omuemu VO, Adeleye, Adams ;

HOD Accounts NAUTH, ?Dr Okoli C; Assistant Director (Principal, SON, NAUTH) Onyejiaka

NN; Pharmacy dept, HOD Pharmacy, Pharm. Obiefuna PE, Pharm. Mrs Egwuatuegwu ; Director

of Administration, NAUTH Mrs Nwofor; HOD Records NAUTH, Okere J; Medical Records

dept NAUTH students , Blessing, Arinze, Godspower Ejenwo; Community Medicine department

residents, Drs. Azuike EC, Ofoegbu C, Igwebike, Administrative Secretary, Mrs Ngozi ; CMD

(Prof. Igwegbe’s) Office NAUTH, Administrative Secretary , Mr. Okeke, Mr. Office; CMAC

(Dr. Afiadigwe’s EE) Office NAUTH, Administrative Secretary, (?name), Mrs Obi, Mrs

Favour; Procurement Department NAUTH, (Assistant Director) Mrs. Ugochukwu, Okpali S.;

Nursing Services Department NAUTH, Okoro James; Administrative dept NAUTH, James; PRO

NAUTH Office, Ngige Kris,Obum; MDCN NAUTH, Dr. Eleje G, ARD NAUTH ,Dr.

Nwajiakor(President),Okham(Secretary);Friends/Associates,Nathaniel,Karen,Nemi,Tarkie,Damij

o,Elohor,Nwaka; Pastors,Adeboye EA,Okenwa B,Udah P,Nkemdili, Nnaka B, Igbokwe I, Ojo I,

REFERENCES

1. World Health Organization. Group at Risk. WHO ‘s report on the tuberculosis

epidemics. Geneva : WHO, 1988.

2.Federal Ministry of Health .National Tuberculosis and Leprosy Control program.

Revised Workers manual 2nd edn., 1998

Wobester W, Yuan L, Naus M. The tuberculosis treatment completion study group.

Outcome of pulmonary tuberculosis treatment in the tertiary care setting- Toronto

1992/93 . CMAJ 1999; 160 : 789-794

1. Global Tuberculosis program. Global tuberculosis control. WHO report 1997 1997 ( rep

no WHO /TB/97.225). Geneva : WHO; 1997 : 9-15

2. Global Tuberculosis program. Global tuberculosis control : Surveillance, planning and

financing. WHO report 2005 (rep. No WHO/ HTM/ TB/ 2005.349). Geneva : WHO ;

2005 : 108-111

3. Salami AK, Oluboyo PO. Management Outcome of Pulmonary tuberculosis: A nine year

review in Illorin. West African J Med 2003; 22 : 114-119

4. Erhabor GE , Adebayo RA, Omodara JA, Famurewa OC. Ten year review of patterns of

presentation and outcome of tuberculosis in Obafemi Awolowo University Teaching

Hospital, Ile-Ife, Nigeria. J Health Sci 2003 ; 3 : 34-39

5. Stop TB partnership. Available from : www.

Stoptb.org/stop_tb_initiative/amsterdam_conference/ Nigeria_speech. Asp (Accessed on

November 24, 2011).

6. Brudney K, Dobkin J. Resurgent tuberculosis in New York city. Human

Immunodeficiency virus, homelessness and the decline of Tuberculosis control programs.

Am Rev Respir Dis 1991; 144: 745-749

7. Slutkin G. Management of tuberculosis in urban homeless indigents. Public Health Resp

1986: 481-485

8. Jaiswal A, Singh V, Ogden JA. Adherence to tuberculosis treatment : lessons from the

urban settings of Delhi, India. Trop Med Int Health 2003; 8 : 625-633

9. Grzybowsky S, Enaarson D. Results in Pulmonary tuberculosis patients under various

treatment programs condition[in French]. Bull Int Union tuberculosis 1978; 53: 70-75

10. Servin T, Atac G, Gungor G. Treatment outcome of relapse and defaulter pulmonary

tuberculosis patients. In J Tuberc Lung Dis 2002; 6: 320-325.

11. Federal Ministry of Health .National Tuberculosis and Leprosy Control program. Revised

Workers manual 5th edn., 2008 : 1-227

12. Naido S, Taylor M, Jinabhai CC. Critical risk factors driving the Tuberculosis epidemic

in Kwa Zulu –Natal, South Africa. South Africa J Epidemiol Infect 2007; 22 (2,3); 45-49

13. Gerado C, Porfirio D , Diego C. The dynamics of pulmonary tuberculosis in Colima,

Mexico (1999-2002). Scandinavian J of Infec Dis 2005; 37 : 858-862

14. Xu L, Gai R, Liu Z, Cheng J. Socio-economic factors affecting the success of

tuberculosis treatment in six countries of Shandong Province, China. Int J TB L Dis 14

(4) : 440-446.

15. Efegbere HA , Onyeyili AN, Anyabolu AE, Enemuo HE, Igwegbe AO, Efegbere EK,

Adogu PO, Ilika AL, Oyeka CI . Effectiveness of Treatment Outcomes of Public Private

Mix Tuberculosis Control Program in Eastern Nigeria. Journal of Biology, Agriculture

and Healthcare. 2014 Vol 4(1) : 1-7.


Adogu PO, Ilika AL, Oyeka CI . Treatment Outcomes of Private-Private Mix

Tuberculosis Control Program in South-Eastern Nigeria. Public Health Research . 2014;

4(2): 45-50. doi:10.5923/j.phr.20140402.01


Adogu PO, Ilika AL, Oyeka CI . Determinants of Treatment Outcome of Public-Private

Mix Tuberculosis Control Programme in South-Eastern Nigeria. Afromedic

Journal ,2014 Jun , Vol. 5 (1): 1-13.


Adogu PO, Ilika AL, Oyeka CI . Determinants of Treatment Outcome of Public Public

Mix Tuberculosis Control Programme in Southeastern Nigeria. American Journal of

Medicine and Medical Sciences, USA. 2015 (in press).

(B.) ASSESSMENT OF PREVALENCE OF CATEGORIES OF TREATMENT OF

PUBLIC MIX TUBERCULOSIS CONTROL PROGRAMME IN SOUTHEASTERN

NIGERIA

ABSTRACT:

The Federal Ministry of Health of Nigeria for tuberculosis(TB) control programme

recommended for standardization two categories of Directly Observed Therapy Short

course(DOTS). The materials and methods utilized were a descriptive retrospective cohort study

design to analyze secondary data set (2007-2010) of patients accessing prevalence categories of

TB-DOTS treatment and outcomes in two comparable private facilities (Immaculate Heart of

Catholic Church Hospital,IHCCH and Diocesan Anglican Communion Hospital,DACH ) in

Anambra State, Nigeria. The results showed different cured , defaulter, interrupted, death and

failure rates outcomes with different categories of treatment for different period of years for the

two different hospitals. In conclusion, Dr TB and Leprosy Control has higher chances of

Multiple Drug Resistant TB patients compared to Nnamdi Azikiwe University Teaching

Hospital.



















Name and addresses of the corresponding authour: Henry A. Efegbere 1, 5







Public Mix

Introduction: WHO grouped patients receiving anti-tuberculosis Directly Observed Therapy

Short course according to the three major treatment categories described by Treatment regimens


administered, however, this study used the standardization of two categories according to the

Federal Ministry of Health of Nigeria.

Materials and Methods: A descriptive retrospective cohort study design used to analyze

secondary data set (2007-2010) of patients accessing TB-DOTS treatment by categories in two

comparable facilities (Nnamdi Azikiwe University Teaching Hospital, NAUTH and Department

of Health Services TBL Control Unit Nnewi North L.G.A. Secretariat, DHSTBLU ) as public in

Nnewi North L.G.A., Anambra State.

Results: In NAUTH (Nnamdi Azikiwe University Teaching Hospital) 24.6% of cured rate

outcome received category 1 while 3.9% of that outcome received category 2 of treatment; 0.5%

of treatment failure rate outcome received category 1 of treatment while 0.4% of that rate

outcome received category 2 of treatment. In DHSTBLU (Department of Health Services TBL

Unit), 54.5% cured rate outcome received category 1 of treatment while 13.1% of that outcome

received category 2 of treatment; 3.6% of failure rate outcome received category 1 of treatment

while 1.6% of that rate outcome received category 2 of treatment. NAUTH had 84.9% of

category 1 of treatment with 15.1% of category 2 of treatment; DHSTBLU had 76.0% of

category 1 of treatment with 24.0% of category 2 of treatment.

Conclusion and Recommendations: Conclusively, DHSTBLC has higher chances of Multi-

Drug Resistant patient load than NAUTH . Adequate Gene Expert diagnostics matched with

enough proficient health professionals made nationally accessible at all levels of health care

delivery that undertake DOTS services. Future research to juxtapose local findings against WHO

standards for standardization of local findings.













NAUTH Office, Ngige Kris,Obum; MDCN NAUTH, Dr. Eleje G, ARD NAUTH ,Dr.

Nwajiakor(President),Okham(Secretary);Friends/Associates,Nathaniel,Karen,Nemi,Tarkie,Damij

o,Elohor,Nwaka; Pastors,Adeboye EA,Okenwa B,Udah P,Nkemdili, Nnaka B, Igbokwe I, Ojo I,

REFERENCES

1. Maimela E. Evaluation of Tuberculosis treatment outcomes and the determinants of

treatment failures in the Eastern Cape Province (2003-2005). A thesis presented to

University of Pretoria, South Africa.2009

2. Akinola AF , Abimbola SO, Afolabi EB. Treatment outcomes among pulmonary

tuberculosis patients at treatment centres in Ibadan, Nigeria. Annals of African Medicine

2009; 8 (2) : 100-104

3. Enwura CP, Emeh MS, Izuehie IS, Enwuru CA, Umeh SI, Agbasi UM.

Bronchopulmonary tuberculosis Laboratory diagnosis and DOTS Strategy outcome in a

rural community. African Journal of clinical and experimental microbiology 2009

4. Antonie D, French CE, Jones J, Watson JM. Tuberculosis treatment outcome monitoring

in England, Wales and Northern Ireland for cases reported in 2001. J Epidemiol

Community Health 2007; 61 : 302-307

5. WHO. Treatment of tuberculosis : guidelines for national programs. 3rd ed. Geneva

2003. Available from URL: http ://www.who.int .(Accessed on July 20,2011).

6. World Bank. Disease Control priorities in Developing countries, 2nd ed; Part II ; selecting

interventions ; Tuberculosis. New York; Oxford University Press 2006.

7. Rodger AJ, Toole M, Lalnuntluangi L, Muana V, Deutschemann P. DOTS –based

tuberculosis treatment and control during civil conflict and an HIV epidemic,

Churachchandpur District, India. Bull WHO vol.80 no.6 Geneva 2002

8. Bulletin of the WHO: Targets for tuberculosis control: how confident can we be about the

data 2007 ; 85; 370-376.

9. WHO . TB/HIV ; A clinical manual.2nd ed. 2004.Available from URL:

http://www.who.int. (Accessed on January 30, 2011 )

10. Department of Health. The South African Tuberculosis control program; practical

guidelines 2000. Available from URL: http://www.doh.org.za (Accessed on June

30,2011).

11. WHO Stop TB Partnership. DOTS Expansion Working Group, Strategic Plan 2006-

2015,2006 ; WHO/HTM/2006.370

12. WHO. Stop TB Partnership. The Stop TB strategy; Building on and enhancing DOTS to

meet the TB-related Millennium Development Goals 2006.

13. Obermeyer Z, Abott –Klafter J, Murray CJL. Has the DOTS Strategy improved case

finding or treatment success ? An Empirical Assessment. PLoS ONE 2008 3(3):

e1721.doi : 10.1371/journal.pone.0001721.

http://www.doh.org.za/

14. Shargie EB, Lindtjorn B. DOTS improves treatment outcomes and service coverage for

tuberculosis in South Ethiopia : a retrospective trend analysis : MBC Public Health 2005;

5: 62

15. Maher D, Hausler HP, Raviglione MC, et al. TB Care in Community organizations in

Sub-Saharan Africa; practice and potential. The Int J Tuberc Lung Dis 1997, 1(3): 276-

283.

16. WHO Community Contribution to TB Care; Practice and Policy 2003 ; WHO/ CDC/

TB/2003.312. [cited 2007 September 26] Available from URL: http://www.who.int.








4(2): 45-50. doi:10.5923/j.phr.20140402.01




Journal ,2014 Jun , Vol. 5 (1): 1-13.





http://www.who.int/

(C.) ASSESSMENT OF PREVALENCE OF CATEGORIES OF TREATMENT OF

PUBLIC PRIVATE MIX TUBERCULOSIS CONTROL PROGRAMME IN

SOUTHEASTERN NIGERIA




Igwegbe AO 7, Oyeka CE 8 ,Ofili AN 9 , Asuzu MC 10 , Onajole TA 11


















Nigeria.










Public Private Mix

1. Introduction:

WHO grouped patients receiving anti-tuberculosis Directly Observed Therapy Short course

according to the three major treatment categories described by Treatment regimens administered,

however, this study used the standardization of two categories according to the Federal Ministry

of Health of Nigeria.

2. Materials and Methods:

A descriptive retrospective cohort study design used to analyze secondary data set (2007-

2010) of patients accessing TB-DOTS treatment in two groups of comparable public and

private facilities .Nnamdi Azikiwe University Teaching Hospital (NAUTH) and


Department of Health Services Tuberculosis and Leprosy Control Unit Nnewi North

Local Government Area Secretariat (DHSTBLU)) as public facilities. Immaculate Heart

of Catholic Church Hospital and Diocesan Anglican Communion Hospital as private

facilities. All in Nnewi North L.G.A., Anambra State, Nigeria.

3. Results:

In public facilities 31.5% of cured rate outcome received category 1 of treatment while 6.1% of

that outcome received category 2 of treatment; 1.2% of failure rate outcome received category 1

of treatment while 0.7% of that outcome received category 2 of treatment .

In private facilities, 50.4% of cured rate outcome received category 1 of treatment while 0.8% of

that rate outcome received category 2 of treatment; 0.8% of treatment failure rate outcome

received only category 2 of treatment.

4. Conclusion:

The private facilities have more chances of Multiple Drug Resistant TB patients compared to the

public facilities. Therefore, its recommended that in order to eliminate the prevalence of Multi-

Drug Resistant Tuberculosis adequate Gene Expert diagnostics matched with enough proficient

health professionals be made nationally accessible at all levels of health care delivery that

undertake DOTS services. Also, future research to juxtapose findings against WHO standards for

internationalization of local findings.













NAUTH Office, Ngige Kris,Obum;MDCN NAUTH,Dr. Eleje G, ARD NAUTH ,Dr.

Nwajiakor(President),Okham(Secretary);Friends/Associates,Nathaniel, Karen, Nemi G, Tarkie

KO, Damijo M,Elohor,Nwaka; Pastors,Adeboye EA,Okenwa B,Udah P,Nkemdili, Nnaka B,

Igbokwe I, Ojo I,

REFERENCES






2009; 8 (2) : 100-104

3. Enwura CP, Emeh MS, Izuehie IS, Enwuru CA, Umeh SI, Agbasi UM.

Bronchopulmonary tuberculosis Laboratory diagnosis and DOTS Strategy outcome in a

rural community. African Journal of clinical and experimental microbiology 2009

4. Antonie D, French CE, Jones J, Watson JM. Tuberculosis treatment outcome monitoring

in England, Wales and Northern Ireland for cases reported in 2001. J Epidemiol

Community Health 2007; 61 : 302-307



6. World Bank. Disease Control priorities in Developing countries, 2nd ed; Part II ; selecting

interventions ; Tuberculosis. New York; Oxford University Press 2006.

7. Rodger AJ, Toole M, Lalnuntluangi L, Muana V, Deutschemann P. DOTS –based

tuberculosis treatment and control during civil conflict and an HIV epidemic,

Churachchandpur District, India. Bull WHO vol.80 no.6 Geneva 2002

8. Bulletin of the WHO: Targets for tuberculosis control: how confident can we be about the

data 2007 ; 85; 370-376.

9. WHO . TB/HIV ; A clinical manual.2nd ed. 2004.Available from URL:

http://www.who.int. (Accessed on January 30, 2011 )

10. Department of Health. The South African Tuberculosis control program; practical

guidelines 2000. Available from URL: http://www.doh.org.za (Accessed on June

30,2011).


2015,2006 ; WHO/HTM/2006.370









http://www.doh.org.za/


4(2): 45-50. doi:10.5923/j.phr.20140402.01




Journal ,2014 Jun , Vol. 5 (1): 1-13.





(D.) DETERMINANTS OF TREATMENT OUTCOMES OF PUBLIC MIX

TUBERCULOSIS CONTROL PROGRAMME IN SOUTH-EASTERN NIGERIA

ABSTRACT:

No reliable method exist to predict which patient will complete Tuberculosis (TB) treatment,

however, failure to complete treatment has been associated with several factors including alcohol

abuse. The materials and methods utilized were a retrospective cohort study design used to

analyze secondary data set (2007-2010) of patients accessing determinants of Tuberculosis –

Directly Observed Therapy Short Course (TB-DOTS) outcomes in two comparable public

facilities (Nnamdi Azikiwe University Teaching Hospital, NAUTH and Department of Health

Services Tuberculosis and Leprosy Control Unit Nnewi North Local Government Area,

DHSTLCU ) , Anambra State. Multivariate Logistic Regression was used to analyze for

determinants. The results showed in 2007-2010 the determinants of treatment outcome at

NAUTH were year, category of treatment and sex of patient for defaulter treatment rate outcome

just as the results varied for failure ,death ;success, among other rates outcomes. In DHSTBLU,

the determinants were year and category of treatment for cured rate outcome; only year for

transferred-out rate outcome; only age for treatment failure rate outcome. Conclusively ,

determinants of treatment outcomes at NAUTH were year, category of treatment, sex and HIV

status of patient while at DHSTLCU, the determinants were year, category of treatment and age.




Igwegbe AO 7, Oyeka CE 8 , Ofili AN 9, Asuzu MC 10 , Onajole TA 11


















Nigeria.








Copyright: This version is nontrivially significantly different from that published by

American Journal of Medicine and Medical Sciences, USA


Key words: Pulmonary Tuberculosis, Determinants, Treatments Outcomes, Public Mix

Background: No reliable method exist to predict which patient will complete Tuberculosis (TB)

treatment, however, failure to complete treatment has been associated with several factors

including alcohol abuse, drug abuse ,homelessness, HIV/AIDS infection , non-compliance to

anti-tuberculosis treatment due to a poor correlation between patient and programme needs and

priorities, relatively long period of treatment, the need for multiple drugs and socio-economic

factors .

Materials and Methods: A retrospective cohort study design used to analyze secondary data set

(2007-2010) of patients accessing determinants of Tuberculosis –Directly Observed Therapy

Short Course (TB-DOTS) outcomes in two comparable public facilities (Nnamdi Azikiwe

University Teaching Hospital, NAUTH and Department of Health Services Tuberculosis and

Leprosy Control Unit Nnewi North Local Government Area [L.G.A.] Secretariat, DHSTLCU )

in Nnewi North L.G.A., Anambra State.

Multivariate Logistic Regression was used to analyze for determinants.

Results: Patients mean age 35.0±3.3. There were 69% (1000 patients) and 57%(250 patients)

males at NAUTH and DHSTLCU respectively.

In 2007-2010 the determinants of treatment outcome at NAUTH were year, category of

treatment and sex of patient for defaulter treatment rate outcome; year and category of treatment

for transferred-out rate outcome; category of treatment for failure rate outcome; year and HIV

status of patients for death rate outcome; year and category of treatment for success rate

outcome. In DHSTBLU, the determinants were year and category of treatment for cured rate

outcome; only year for transferred-out rate outcome; only age for treatment failure rate outcome.

Conclusion: Determinants of treatment outcomes at NAUTH were year, category of treatment,

sex and HIV status of patient while at DHSTLCU, the determinants were year, category of

treatment and age. Therefore, its recommended, further research to focus on the determinants for

disaggregated respective years, identify centre-specific factors associated with poor treatment

outcome ,emphasise the place of treatment success rate and analyse primary data set for

Tuberculosis epidemiological profiling and comprehensiveness .
















Igbokwe I, Ojo I.

REFERENCES






2009; 8 (2) : 100-104




2015,2006 ; WHO/HTM/2006.370










4(2): 45-50. doi:10.5923/j.phr.20140402.01




Journal ,2014 Jun , Vol. 5 (1): 1-13.

9. Stop TB . A position paper: A call for Public –Private Mix to strengthen TB Control in

Nigeria.2011: 1-4

10. National Tuberculosis and Leprosy Control Programme 2009 Annual Report. Federal

Ministry of Health Abuja. Federal Ministry of Health publication. May 2010.1-21.

11. Ukwuaja KN, Ifebunadu NA, Osakwe PC, Alobu I. Tuberculosis Treatment Outcome and

its Determinants in a Tertiary care setting in Southeastern Nigeria. Niger Postgrad Med J

2013 Jun; 20(2): 125-129.

(E. ) EVALUATION OF THE ECONO-SYNERGISTIC MODEL OF INTERNATIONAL

RESEARCH NETWORK & SCHOOL ON HEALTH SYSTEM MANAGEMENT AND

ECONOMICS IN SOUTH-EASTERN NIGERIA

ABSTRACT:

The concerns of escalating multiple disease burdens (epidemiological transition) with limited

donor funds and debates of sustainability are legitimate due to the magnitude of expenditure on

health services. Methodologically, the leadership of the Cashville Group of Companies and

Partners had partnership with the Nnamdi Azikiwe University Teaching Hospital (NAUTH)

Management Board. The results were formation and operationalization of inter-dependent

twenty-five firms, all profitably thriving. Conclusively, the workability of the model is in no

doubt successful, customizable and adaptable to any system, for internally generated revenue.
























Copyright: This version is nontrivially significantly different from that soon to be published

by Journal of Economics and Sustainable Development, USA

Introduction: The concerns of escalating disease burden with limited donor funds and debates

of sustainability are legitimate due to the magnitude of expenditure on health services which


account for as much as 5 % of GDP and between 5% and 10% of government expenditures in

developing countries , though this falls below the Abuja target of 15% of government

expenditure allocated to the health sector.1,2

Methodology: The leadership of the Global Community Health Foundation empathized with the

situation of incessant under-subventions to public health facilities including NAUTH initiated

this hybridized model of sustainability as alternative to funding of institutions ,the NAUTH in

particular. The Global Community Health Foundation and partners had partnership with the

Nnamdi Azikiwe University Teaching Hospital (NAUTH) Management Board.

The Steering Committee constituted of the GCHF and NAUTH management.

The agreed approaches were institutionalization of sustainability instruments by research,

interprofessional journals, Businesses, Institutes, Centres and schools.

Results: The tripartite public-private partnership model inspired the realization of the following

independent business models, which are have been incorporated at the Corporate Affairs

Commission of the Federal Government of Nigeria. Some of the firms thereby inspired by this

model are/were: International Institute of Leadership, Management and Economics

LTD/GTE;International Institute of Science, Education and Technology LTD/GTE;International

Centre of Leadership, Management and Economics LTD/GTE;The Journal of Global

Community Inter-professional Practices LTD; Cashville Multipurpose Cooperative Society

International LTD; Cashville Microfinance Bank LTD (with Nigeria nationwide and

worldwide coverage);International Association of Professionals of Leadership, Management and

Economics; International Association of Professionals of Science, Education and Technology;

International Association of Consultants of Leadership, Management and

Economics;International Association of Professionals of Science, Education and Technology;

Cashville Consults LTD/GTE; The Brethren Centre International Ministry; Cashville University

with pilot proposed locations in Delta and Anambra States, Nigeria; Aminu Kano-Cashville

University with pilot proposed locations in Kano and Katsina States, Nigeria; Global Community

University with pilot proposed locations in Abuja and Nasarawa States, Nigeria); The three

models of universities names shall be systematically up-scaled to all countries of Africa based on

outcomes of the pilot programming of about five years in Nigeria; Cashville Modular Refineries

with proposed location in Kano, Bauchi, Benue and Ekiti States of Nigeria. The model of

refinery name shall be systematically up-scaled to all countries of Africa based on outcomes of

the pilot programming of about five years in Nigeria;Cashville Agricultural Village. The Pilot

projects shall be in FCT-Abuja and Anambra States of Nigeria. The model of that name shall be

systematically up-scaled to all countries of Africa based on outcomes of the pilot programming

of about five years in Nigeria; Cashville Trade Centre. The Pilot projects shall be in FCT-Abuja

and Anambra States of Nigeria. The model of that name shall be systematically up-scaled to all

countries of Africa based on outcomes of the pilot programming of about five years in Nigeria;

Cashville Industrial Park. The Pilot projects shall be in FCT-Abuja and Anambra States of

Nigeria. The model of that name shall be systematically up-scaled to all countries of Africa

based on outcomes of the pilot programming of about five years in Nigeria; Cashville Insurance

Ltd.

Conclusion and Recommendations: The workability of the model is in no doubt successful,

customizable and adaptable to any system, more so that the up-scalability increased from the

Eastern Nigeria to different geo-political zones of Nigeria. Therefore, recommendable, its is

highly needfulness to boost income generating activities (IGA) of health and non-health

facilities. It’s not limited to health professionals only. Its universally friendly. It enforces

management of resources in an economic manner. All systems should embrace it for

sustainability of resources.

















Igbokwe I, Ojo I.

REFERENCES

1. Winslow, C.E.A. (1920) The Untitled field of Public Health. Modecine 2 : 183-191

2. Leighton, C. & Makinen, M.(1999) Health Sector reforms in Sub-Sahara Africa .In paper

presented in a workshop. Addis Ababa, Ethiopia; 1999

3. World Bank. World Development Report 1993: Investing in health. Oxford University

Press, Oxford.1993.

4. Makan B, Valentine N, and Kirigia JM.Looking back and Looking ahead: South Africa”s

1995/1996 health budget. 1996: Budget Watch.2:4

5. Murray CJL and Frenk JA. WHO framework for health systems performance assessment.

GPE Discussion paper no 6. Geneva: WHO .1996

6. WHO. The WHO Report 2000: health systems improving performance. Geneva:

WHO:2000

7. Kirigia JM, Sambo LG and Lambo E.A RE PUBLIC HOSPITALS IN Kwazulu/Natal

Province of South Africa technically efficient? African Journal of Health Sciences 2000,

7(3-4): 25-32.

8. World Bank: The Millennium Development Goals for health : rising to the challenges.

Washington DC, World Bank ; 2004

9. Ghana Macroeconomics and Health: Scaling –Up Health Investments for Better Health,

Economic Growth and Accelerated Poverty Reduction. Report of the Ghana

Macroeconomics and Health Initiative ; 2005

(F.) EFFECTIVENESS OF TREATMENT OUTCOMES OF PUBLIC PRIVATE MIX

TUBERCULOSIS CONTROL PROGRAM IN EASTERN NIGERIA

ABSTRACT:

Effective tuberculosis treatment has been shown to have significant effect on the control of

tuberculosis. Methodologically, descriptive statistics with a retrospective cohort study design

used to analyze secondary data set(2007-2010) of patients accessing TB-DOTS treatment in two

facilities (Nnamdi Azikiwe University Teaching Hospital, NAUTH and Department of Health

Services Tuberculosis and Leprosy Control Unit Nnewi North Local Government Area,

DHSTLCU ) as public health facilities and other two facilities (Immaculate Heart of Catholic

Church Hospital, IHCCH and Diocesan Anglican Communion Hospital, DACH) as private

health facilities in Nnewi North, Anambra State. Using WHO standards the health facilities

adjudged as efficient were: in 2007-2010, private facilities like public facilities using different

indicators were efficient at different periods. In conclusion, private health facilities were more

effective than public health facilities over the four period.






















Nigeria.








Copyright: This version is nontrivially significantly different from that published by Journal

of Biology, Agriculture and Health, USA

Introduction: Effective tuberculosis treatment has been shown to have significant effect on the

control of tuberculosis.Completion of treatment of active cases is therefore the most important

priority of tuberculosis control programmes.

Methodology: Descriptive statistics with a retrospective cohort study design used to analyze

secondary data set(2007-2010) of patients accessing TB-DOTS treatment in two facilities

(Nnamdi Azikiwe University Teaching Hospital, NAUTH and Department of Health Services

Tuberculosis and Leprosy Control Unit Nnewi North Local Government Area (L.G.A.)

Secretariat, DHSTLCU ) as public health facilities and other two facilities (Immaculate Heart of

Catholic Church Hospital, IHCCH and Diocesan Anglican Communion Hospital, DACH) as

private health facilities in Nnewi North L.G.A., Anambra State.


Results: Gender of patients were male: female54%(1016 patients) : 46% (883 patients) and

53%(63 patients) : 47%(56 patients) in public and private health

facilities respectively . Using WHO (1996) standards the health facilities adjudged as efficient

were: in 2007,private facilities using the indicator of treatment failure rate; private facilities

using the indicator of death rate; public facilities and private facilities using the indicator of

transfer-out rate ; public facilities using the indicator of treatment completion rate. In 2008,

effective health facilities were: private health facilities using the indicator of failure rate; public

and private health facilities using the indicator of transfer-out rate; private facilities using the

indicator of treatment completion rate. In 2009, effective health facilities were public and private

health facilities using indicator of treatment failure rate; public and private health facilities using

the indicator of death rate; public and private facilities using the indicator of transfer out; public

and private facilities using the indicator of treatment completion rate. In 2010, effective health

facilities were: private health facilities using the indicator of cure rate; private facilities using the

indicator of death rate ; public and private facilities using the indicator of transfer-out; public

facilities using the indicator of treatment completion rate.

Conclusion and Recommendations: private health facilities were more effective than public

health facilities by the several indicators over the four year period. Thus, its recommended,

future research is needful to use primary and secondary data sets in assessment of TB control

program effectiveness; technical efficiency assessment using non-parametric statistics will assess

the validity of assessing effectiveness using only the WHO standards; identify centre-specific

factors associated with poor treatment outcome; institutionalizing a reward system for effective

TB-DOTS facilities will engender healthy competition in the Public Private Mix for sustained

effectiveness; the Monitoring and Evaluation tools especially the treatment card for data capture

should be improved upon for comprehensiveness of patients socio-economic history.

Keywords: Tuberculosis, Effectiveness, Treatments Outcomes, Public Private Mix

REFERENCES

1. World Health Organization. Group at Risk. WHO ‘s report on the tuberculosis

epidemics. Geneva : WHO, 1988.

2. Federal Ministry of Health .National Tuberculosis and Leprosy Control program.

Revised Workers manual 2nd edn., 1998.

3. Wobester W, Yuan L, Naus M. The tuberculosis treatment completion study group.

Outcome of pulmonary tuberculosis treatment in the tertiary care setting- Toronto

1992/93 . CMAJ 1999; 160 : 789-794.

4. Global Tuberculosis program. Global tuberculosis control. WHO report 1997 1997 ( rep

no WHO /TB/97.225). Geneva : WHO; 1997 : 9-15

5. Global Tuberculosis program. Global tuberculosis control : Surveillance, planning and

financing. WHO report 2005 (rep. No WHO/ HTM/ TB/ 2005.349). Geneva : WHO ;

2005 : 108-111

6. Salami AK, Oluboyo PO. Management Outcome of Pulmonary tuberculosis: A nine year

review in Illorin. West African J Med 2003; 22 : 114-119

7. Erhabor GE , Adebayo RA, Omodara JA, Famurewa OC. Ten year review of patterns of

presentation and outcome of tuberculosis in Obafemi Awolowo University Teaching

Hospital, Ile-Ife, Nigeria. J Health Sci 2003 ; 3 : 34-39

8. Stop TB partnership. Available from : www.

Stoptb.org/stop_tb_initiative/amsterdam_conference/ Nigeria_speech. Asp (Accessed on

November 24, 2011).

9. Brudney K, Dobkin J. Resurgent tuberculosis in New York city. Human

Immunodeficiency virus, homelessness and the decline of Tuberculosis control programs.

Am Rev Respir Dis 1991; 144: 745-749

10. Slutkin G. Management of tuberculosis in urban homeless indigents. Public Health Resp

1986: 481-485

11. Jaiswal A, Singh V, Ogden JA. Adherence to tuberculosis treatment : lessons from the

urban settings of Delhi, India. Trop Med Int Health 2003; 8 : 625-633

12. Grzybowsky S, Enaarson D. Results in Pulmonary tuberculosis patients under various

treatment programs condition[in French]. Bull Int Union tuberculosis 1978; 53: 70-75

13. Servin T, Atac G, Gungor G. Treatment outcome of relapse and defaulter pulmonary

tuberculosis patients. In J Tuberc Lung Dis 2002; 6: 320-325.

14. Federal Ministry of Health .National Tuberculosis and Leprosy Control program. Revised

Workers manual 5th edn., 2008 : 1-227

15. Naido S, Taylor M, Jinabhai CC. Critical risk factors driving the Tuberculosis epidemic

in Kwa Zulu –Natal, South Africa. South Africa J Epidemiol Infect 2007; 22 (2,3); 45-49

16. Gerado C, Porfirio D , Diego C. The dynamics of pulmonary tuberculosis in Colima,

Mexico (1999-2002). Scandinavian J of Infec Dis 2005; 37 : 858-862

17. Xu L, Gai R, Liu Z, Cheng J. Socio-economic factors affecting the success of

tuberculosis treatment in six countries of Shandong Province, China. Int J TB L Dis 14

(4) : 440-446.








4(2): 45-50. doi:10.5923/j.phr.20140402.01




Journal ,2014 Jun , Vol. 5 (1): 1-13.





(G.) PREVALENCE OF HEALTH WORKERS SATISFIED WITH THEIR JOB IN

SOUTH-EASTERN NIGERIA.

The objective of this study was to assess prevalence of health workers with job satisfaction in

South-eastern Nigeria. Methodologically, descriptive , cross sectional study design was utilized.

The self-administered questionnaire used by participants was adapted from The Minnesota

Satisfaction Questionnaire Short Form to assess job satisfaction .Results showed there was no

difference between overall level of satisfaction using the Minnesota Satisfaction Questionnaire

Short Form and perception rating of respondents. Conclusively, the study showed a high level of

job satisfaction among health workers, hence, the recommendation, improvement in various

domains of job dissatisfaction in order to reduce attrition and high turn-over of workers.




Igwegbe AO 7, Oyeka CE 8 , Ofili AN9 , Asuzu MC 10 , Onajole TA 11























Introduction : There has been several studies on prevalence of workers with their job

satisfaction among different groups of workers in different fields but very few of such studies

have been carried out specifically among Health workers in south-eastern Nigeria.

Objective: To assess prevalence of health workers with job satisfaction among Health

Workers in South-eastern Nigeria.

Methodology : This descriptive , cross sectional study was conducted in May, 2014. The self-

administered questionnaire used by participants was adapted from The Minnesota Satisfaction

Questionnaire Short Form to assess job satisfaction .


Results: One hundred and forty five out of the 150 workers eligible for the study completely

filled and returned their questionnaires. There was no difference between overall level of

satisfaction using the Minnesota Satisfaction Questionnaire Short Form and perception rating of

respondents, thus, about 64.1 % of respondents were either satisfied or very satisfied with their

jobs while 35.9 % of workers were either dissatisfied or very dissatisfied. About 50.4% of

workers were above 40 years of age, and 62.1% were married. There were more females (73%)

than males (26%). Almost all workers were Christians as well as were of Igbo origin in tribe.

Conclusion: The study showed a high level of job satisfaction among Health workers.

Recommendation: Improvement in various domains of job dissatisfaction in order to reduce

attrition and high turn-over of workers is highly recommended.

Keywords: Prevalence, job satisfaction; health workers; Nigeria
















Igbokwe I, Ojo I.

REFERENCES

1. Friedman JP. Baron’s Dictionary of Business Terms. 4 th ed. Baron’s Educational Series: New

York. 2007:1-1011

2. Okaro AO, Eze CU, Ohagwu CC. Survey of Job satisfaction among radiographers in South-

Eastern Nigeria. European Journal of Scientific Research 2010; 39 (3): 448-456.

3. Jennifer L, Kettle RN. Factors affecting job satisfaction in the registered nurse. Health

Science Journal.2009; 2(4): 23-29.

4. Gothe H, Koster A, Storz P, Nolting H, Haussler B. Job satisfaction among doctors.

Haudtsch Arztebl 2007; 104 (20): 1394-9.

5. Donuk B. The comparison of the job satisfactions of the sport managers who work in private

and public sectors. Selcuk Universitesi Sosyal Bilimler Enstitusu Dergisi 2009; 21: 179-185.

6. Ezeja EB, Azodo CC, Ehiezele AO, Ehigiator O, Oboro HO. Assessment of work satisfaction

and working conditions of Nigerian health workers. Int. J. Biomed & Hlth. Sci. 2010; 6 (3):

143-150.

7. Ofili AN, Asuzu MC, Isah EC, Ogbeide O. Job satisfaction and psychological health of

doctors at the University of Benin Teaching Hospital. Occupational Medicine . 2004; 54:

400-403.

8. Murrels T, Robinson S, and Griffiths P. Job satisfaction trends during nurses early career.

BMC Nursing 2008; 7: 7.

9. Omolase CO Seidu MA Omolase BO Agborubere DE. Job satisfaction among Nigerian

Ophthalmologist : an exploratory study. Libyan J Med 2010 , 5: 4629

10. Amoran OE, Omokhodion FO, Dairo MD, Adebayo AO. Job satisfaction among Primary

Health Care workers in three selected local government areas in southwest Nigeria. Niger J

Med. 2005 ; 195-199

11. Al-Eisa IS, Al-Muta MS, AL-Abduljalil HK. Job satisfaction of Primary Health Care

physicians at Capital Health Region, Kuwait. MEJFM. 2005; 3 (3) : 2-5

12. Liu JA, Wang QI, Lu ZX. Job satisfaction and its modelling among Township Health

Centre employees: a quantitative study in poor rural China. BMC Health Service. 2010; 23:

43-51.

13. Obionu CN. Primary health care in developing countries. 2nd ed. Enugu. Evanseenio; 2007: 1-

386.

14. World Health Organization. Alma Ata 1978 Primary Health Care. Geneva: WHO, 1978: 1-

80.

15. World Health Organization. The World Health Report 2008-Primary Health Care : Now

more than ever.2008: 1-4.

16. Federal Ministry of Health of Nigeria. Revised National Health Policy: Abuja. 2004: 1-66.

17. Mosadeghrad AM, Ferlie E, Rosenberg D. A study of the relationship between job

satisfaction, organizational commitment and turnover intention among hospital employees.

Health Serv Manage Res 2008; 21: 211-227.

18. Society for Human Resource Management (SHRM). Employee job satisfaction:

Understanding the factors that make work gratifying. Mumbai, India. 2009: 1-52.

19. Mojoyinola JK. Effects of Job stress on health, personal and work behaviour of nurses in

public hospitals in Ibadan metropolis, Nigeria. Ethno-Med. 2008; 2(2): 143-148.

20. Blengen MA. Nurses job satisfaction: a meta-analysis of related variables. Nur Res. 1993;

42(1) : 36-41.

21. Saane NV, Sluiter JK, Verbeek JHAM, Frings-Dresen MHW. Reliability and validity of

instruments measuring job satisfaction- a systemic review. Occupational Medicine.2003; 53:

191-200.

22. Job satisfaction :en .wikipedia.org/wiki (accessed 2011 June 11)

23. Job descriptive index : www.humanresources.hrvinet.com (accessed 2011 June 13)

(H.) PREVALENCE OF FACTORS AFFECTING JOB SATISFACTION OF

HEALTH WORKERS IN SOUTH-EASTERN NIGERIA.

ABSTRACT:

The aim of this study was to assess factors affecting job satisfaction of Health Workers in

South-eastern Nigeria. Methodologically, this study used descriptive , cross sectional study

design. Results showed there was no difference between overall level of satisfaction using the

Minnesota Satisfaction Questionnaire Short Form and perception rating of respondents.

Conclusively, there high level of job satisfaction among Health workers. Improvement in various

domains of job dissatisfaction in order to improve effective and efficient utilization of resources

among workers is highly recommended.






















Nigeria.









Introduction : There has been several studies on factors affecting job satisfaction among

different groups of workers in different fields but very few of such studies have been carried out

specifically among Health workers in south-eastern Nigeria.

Objective: To assess factors affecting job satisfaction of Health Workers in South-eastern

Nigeria.



administered questionnaire used by participants was adapted from The Minnesota Satisfaction

Questionnaire Short Form to assess job satisfaction.








Factors that influenced the workers’ level of job satisfaction were age, marital status, tribe ,

educational qualification and ranks/ cadre. Of the 18 domains of job satisfaction , workers were

dissatisfied with salary, other benefits, skills utilization, motivation, career development and rate

of promotion at work.

Conclusion: The study showed a high level of job satisfaction among Health workers.

Recommendation: Improvement in various domains of job dissatisfaction in order to improve

effective and efficient utilization of resources among workers is highly recommended.

Keywords: factors, job satisfaction; health workers, Nigeria
















Igbokwe I, Ojo I.

REFERENCES




Centre employees: a quantitative study in poor rural China. BMC Health Service. 2010;

23: 43-51.

3. Obionu CN. Primary health care in developing countries. 2nd ed. Enugu. Evanseenio;

2007: 1-386.

4. World Health Organization. Alma Ata 1978 Primary Health Care. Geneva: WHO, 1978:

1-80.



6. Federal Ministry of Health of Nigeria. Revised National Health Policy: Abuja. 2004: 1-

66.


satisfaction, organizational commitment and turnover intention among hospital

employees. Health Serv Manage Res 2008; 21: 211-227.





10. Blengen MA. Nurses job satisfaction: a meta-analysis of related variables. Nur Res.

1993; 42(1) : 36-41.


instruments measuring job satisfaction- a systemic review. Occupational Medicine.2003;

53: 191-200.



14. Kebriaei A, Moteghed MS: Job satisfaction among community health workers in

Zahedan district, Islamic Republic of Iran. La Revue de Sante de la Mediterannee

Orientale. 2001; 15: 5-7.

15. Bodur S. Job satisfaction of health care staff employed at health centres in Turkey.

Occup. Med. 2002; 52 (6): 353-355.

16. Ofili AN. A comparative study of job dissatisfaction among doctors and nurses at the

University of Benin Teaching Hospital, Benin City, Edo State, Nigeria. Project report,

Faculty of Community Health, West African Postgraduate Medical College, April

1998;90.

17. Willis-Shattuck M, Bidwell P, Thomas S, Wyness L, Blaauw D, Ditlopo P.Motivation

and retention of health workers in developing countries: a systematic review. BMC

Health Services Research.2008; 8: 247.

18. Chen LC, Boufford JI. Fatal flows-Doctors on the move. N Engl J Med 2005; 353: 1850-

1852.

19. Ebuehi OM , Campbell PC. Attraction and retention of qualified health workers to rural

areas in Nigeria: a case study of four LGAs in Ogun State Nigeria .Rural Remote

Health.2011; 11: 1515.

20. Ali N. Factors affecting overall job satisfaction and turnover retention. Journal of

Managerial Sciences. 2005; 2(2): 239-252.

21. Rehab Measures: General Health Questionnaire(GHQ) -28.

www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=909:1-3(accessed

February 26,2014).

http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=909:1-3(accessed

(I.) ASSESSING JOB STRESS AND PSYCHOLOGICAL HEALTH OF HEALTH

WORKERS IN SOUTH-EASTERN NIGERIA.

ABSTRACT:

The objective of this study was to assess job stress and psychological health of health workers

in South-eastern Nigeria. Methodologically, this study utilized descriptive , cross sectional study

design. Results revealed the proportion of workers with psychological disorder increased with

the level of dissatisfaction but this was not statistically significant. The proportion of workers in

this study with psychological disorder increased with the proportion of workers stressed up and

this association was statistically significant. Conclusively, there is association between stress and

psychological disorder. Improvement in various domains of job dissatisfaction in order to reduce

job stress and psychological disorder among workers is highly recommended.




Igwegbe AO 7, Oyeka CE 8 , Ofili AN 9 ,Asuzu MC 10 , Onajole TA 11


















Nigeria.









Introduction : There has been several studies on job stress and psychological health among

different groups of workers in different fields but very few of such studies have been carried out

specifically among Health workers in southeastern Nigeria.


Objective: To assess job stress and psychological health of Health Workers in South-eastern

Nigeria.


administered questionnaire used by participants was adapted from a study by Ofili et al to assess

job stress and The General Health Questionnaire 28 to assess psychological health disorder.


filled and returned their questionnaires. About 50.4% of workers were above 40 years of age,

and 62.1% were married. There were more females (73%) than males (26%). Almost all workers

were Christians as well as were of Igbo origin in tribe.

Using the General Health Questionnaire (GHQ) thirty one percent of workers had score of 4 and

above, and were at increased likelihood of having a psychological disorder. About 74.5% of

workers were stressed up with 26 % of workers having their source of stress from outside their

jobs. The proportion of workers with psychological disorder increased with the level of

dissatisfaction but this was not statistically significant.

The proportion of workers in this study with psychological disorder increased with the

proportion of workers stressed up and this association was statistically significant.

Conclusion: The study showed there is association between stress and psychological disorder.

Recommendation: Improvement in various domains of job dissatisfaction in order to reduce job

stress and psychological disorder among workers is highly recommended.

Keywords: Job stress; psychological disorder; health workers; Nigeria
















Igbokwe I, Ojo I.

REFERENCES





23: 43-51.


2007: 1-386.


1-80.




66.









1993; 42(1) : 36-41.



53: 191-200.





Orientale. 2001; 15: 5-7.


Occup. Med. 2002; 52 (6): 353-355.




1998;90.





1852.



Health.2011; 11: 1515.





February 26,2014).

22. Odebunmi SO. Assessment of job satisfaction among Primary Health Care workers in

Lagos Island Local Government Area. Master of Public Health ( MPH) project,

University of Lagos, Lagos State, Nigeria. June 2011: 1-50


(J.) INVESTIGATING HOW JOB STRESS AND PSYCHOLOGICAL HEALTH

RELATE TO JOB SATISFACTION OF HEALTH WORKERS IN SOUTH-

EASTERN NIGERIA.

ABSTRACT:

The aim of this study was to investigate how job stress and psychological health relate to job

satisfaction of health workers in Southeastern Nigeria. Methodologically, descriptive , cross

sectional study design was used. Results demonstrated the proportion of workers with

psychological disorder increased with the level of dissatisfaction but this was not statistically

significant. The proportion of workers in this study with psychological disorder increased with

the proportion of workers stressed up and this association was statistically significant. Stress

increased with the level of dissatisfaction but this was not statistically significant. Conclusively,

there is association between stress and psychological disorder but no association between job

satisfaction and any of stress and psychological disorder. Improvement in various domains of

job dissatisfaction in order to reduce job stress and psychological disorder among workers is

highly recommended.




Igwegbe AO 7, Oyeka CE 8 ,Ofili AN 9 , Asuzu MC 10 , Onajole TA 11


















Nigeria.










Introduction : There has been several studies on job stress, job satisfaction and psychological

health among different groups of workers in different fields but very few of such studies have

been carried out specifically among Health workers in southeastern Nigeria.

Objective: To assess job stress, job satisfaction and psychological health of Public Primary

Health Care Workers in Southeastern Nigeria.


administered questionnaire used by participants was adapted from a study by Ofili et al to assess

job stress, The Minnesota Satisfaction Questionnaire Short Form to assess job satisfaction and

The General Health Questionnaire 28 to assess psychological health disorder.








Factors that influenced the workers’ level of job satisfaction were age, marital status, tribe ,

educational qualification and ranks/ cadre. Of the 18 domains of job satisfaction , workers were

dissatisfied with salary, other benefits, skills utilization, motivation, career development and rate

of promotion at work.

Using the General Health Questionnaire (GHQ) thirty one percent of workers had score of 4 and

above, and were at increased likelihood of having a psychological disorder. About 74.5% of

workers were stressed up with 26 % of workers having their source of stress from outside their

jobs. The proportion of workers with psychological disorder increased with the level of

dissatisfaction but this was not statistically significant.

The proportion of workers in this study with psychological disorder increased with the

proportion of workers stressed up and this association was statistically significant. Stress

increased with the level of dissatisfaction but this was not statistically significant.

Conclusion: The study showed a high level of job satisfaction among Public Primary Health

Care workers. While there is association between stress and psychological disorder there is no

association between job satisfaction and any of stress and psychological disorder.

Recommendation: Improvement in various domains of job dissatisfaction in order to reduce job

stress and psychological disorder among workers is highly recommended.

Keywords: Job stress; job satisfaction; psychological disorder; health workers
















Igbokwe I, Ojo I.

REFERENCES





23: 43-51.


2007: 1-386.


1-80.




66.









1993; 42(1) : 36-41.



53: 191-200.





Orientale. 2001; 15: 5-7.


Occup. Med. 2002; 52 (6): 353-355.




1998;90.





1852.



Health.2011; 11: 1515.





February 26,2014).

22. Odebunmi SO. Assessment of job satisfaction among Primary Health Care workers in

Lagos Island Local Government Area. Master of Public Health ( MPH) project,

University of Lagos, Lagos State, Nigeria. June 2011: 1-50


(K.) PREVALENCE OF ATTITUDE OF TEAM BUILDING AMONG HEALTH

WORKERS IN TWO FEDERAL TERTIARY HEALTH FACILITIES IN SOUTHERN

NIGERIA.

ABSTRACT :

Team building has been found to improve the effectiveness and efficiency of workforce in the

healthcare system generally. The aim of this study was to assess training on team building on the

attitude of health workers in two federal tertiary health facilities in Southern Nigeria.

The materials and methods used included a quasi-experimental study. Multistage sampling

technique was used to select a total of 242 subjects from ten categories of professionals of study

group (Nnamdi Azikiwe University Teaching Hospital) and control group (Federal Medical

Centre). The study phases were pre-intervention, intervention and post-intervention. There was

also statistical significant difference across all variables as determined by chi-square test

(p<0.01) between the pre-intervention and post-intervention phases of study group . In

conclusion, team building was effective in improving attitude of health workers in healthcare in

the study tertiary health facility.





1. Department of Community Medicine, Nnamdi Azikiwe University Teaching Hospital

, Nnewi, Anambra State, Nigeria.







5. Cashville Group of Companies and Partners, worldwide (25 inter-dependent firms).








10. Department of Community Medicine, University College Hospital, Ibadan, Oyo

State, Nigeria.










Introduction : Team building has been found to improve the effectiveness and efficiency of

workforce in the healthcare system generally.

Objective: To assess training on team building on the attitude of health workers in two federal

tertiary health facilities in Southern Nigeria.

Materials and Methods: This was a quasi-experimental study carried out between November

2013 and February 2014. Multistage sampling technique was used to select a total of 242

subjects from ten categories of professionals of study group (Nnamdi Azikiwe University

Teaching Hospital, NAUTH Nnewi) and control group (Federal Medical Centre , FMC Asaba)

with 121 subjects in each group. The study consisted of a pre-intervention, intervention and post-

intervention phases. Subjects participated in the study using same self-administered

questionnaire for study and control groups at pre-intervention and post-intervention (three

months interval) phases. The training intervention instituted used a mix of conceptual framework

of the Health Belief Model and others.

Results: At pre-intervention phase baseline information on the 15 variables of knowledge and

attitude of team building were collected. This consisted of respondents that believed team

building may result to benefits in their organization, those that may participate in team building

if given an opportunity, those that may recommend it to improve inter-professional working

relationship, those that believed it may be a waste of time and money, those that may recommend

it to resolve conflict, those that believe to be an effective team member the attitude competencies

to possess may include (a)assertive behaviour,(b) cooperative attitude and (c) courage to

disagree.

During the intervention phase , training on team building was successfully conducted in three

days for study group.

At post-intervention phase, the same data collected during the pre-intervention phase was

collected again at each site. The data from each site was analyzed separately and the results were

compared. The attitude towards team building among health workers at pre-intervention phase

for study and control groups for the eight variables showed that respondents with appropriate

responses were more than 50% for the two groups except for two variables which are the belief

to be an effective team member the attitude competencies to possess should include assertive

behaviour where respondents that agreed to it were 36.6% and 75.6% for study and control

groups respectively while the other variable the belief to be an effective team member the

attitude competencies to possess should include courage to disagree where those that agreed to it

were 47.6% and 59.3% for study and control groups respectively. Proportion of respondents with

appropriate responses were more in control group than the study group for all variables of

attitude.

There was also statistical significant difference across all variables as determined by chi-square

test (p<0.01) between the pre-intervention and post-intervention phases of study group with the

exception of 1 variable whereas there was statistical significant difference in only 2 variables

between the pre-intervention and post-intervention phases of control group .

Conclusion: Proportion of respondents with appropriate responses were more in control group

than study group for all 8 variables of attitude at pre-intervention phase. Team building was

effective in improving attitude of health workers in healthcare in the study tertiary health

facility.

Recommendation: The Federal Ministry of Health of Nigeria should formulate and implement

policy on attitude of team building for the three tiers of healthcare delivery in Nigeria.

Keywords: Training, Team building, Attitude , health workers
















Igbokwe I, Ojo I.

REFERENCES

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who.int/workforcealliance/countries/Nigeria_HRHStrategicPlan_2008_2012.pdf

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9. Ogbimi RI. Career development: the unexplored source of job satisfaction in the Nigerian

health care delivery system. Journal Nig Inst Mgt. 2007; 38: 23-33.

10. Sweet SJ, Norman IJ. The nurse-doctor relationship: a selective literature review. J of

Adv Nursing. 2005; 22: 165-170.

11. Health Nairaland Forums. Why the professional rivalry and disharmony among medical

and health workers? 2012 May 11[cited 2012 October 2 ]:20 .Available from

http://www.nairaland.com/935694/why-professional-rivalry-disharmony-among


http://www.sciencepub.net/researcher/research%200205/01_0880_research%200205_1-4.pdf


http://www.biomedcentral.com/1472-6955/5/2

http://www.chsrf.ca/

12. Alubo SO. The political economy of doctors strike in Nigeria: a maxist interpretation.

Soc Sc Med. 2008; 22: 467-477.

13. Institute of Health Service Administration of Nigeria at the 2007 National Conference/

General Meeting and National workshop. In J inst. 2007; 3(1): 45-46.

14. Abiodun AJ. Patients satisfaction with quality attributes of primary health care services in

Nigeria. J Health Mgt. 2010; 12 (1): 39-59.

15. Leggat SG. Effective healthcare teams require effective team members : defining

teamwork competencies. BMC Health Services Research .2007[cited 2012 May 5]; 7:17

(L.) PREVALENCE OF KNOWLEDGE OF TEAM BUILDING AMONG HEALTH

WORKERS IN TWO FEDERAL TERTIARY HEALTH FACILITIES IN SOUTHERN

NIGERIA.

ABSTRACT:


healthcare system generally. The objective of this study was to assess training on team building

on the knowledge of health workers in two federal tertiary health facilities in Southern Nigeria.

The materials and methods utilized included a quasi-experimental study. Multistage sampling



Centre). The study consisted of a pre-intervention, intervention and post-intervention phases.


test (p<0.01) between the pre-intervention and post-intervention phases of study group.

Conclusively, the proportion of respondents with appropriate responses were more in control

group than study group.





1. Department of Community Medicine, Nnamdi Azikiwe University Teaching Hospital

, Nnewi, Anambra State, Nigeria.







5. Cashville Group of Companies and Partners, worldwide (25 inter-dependent firms).








10. Department of Community Medicine, University College Hospital, Ibadan, Oyo

State, Nigeria.












Objective: To assess training on team building on the knowledge of health workers in two

federal tertiary health facilities in Southern Nigeria.










Results: Majority 40.2% and 54.6% were in the age group of 41-50 years and 21-30 years for

study and control groups respectively. Majority 68.3% and 75.6% for study and control groups

respectively were female. Most 81.5% and 74.6% for study and control groups respectively had

first degree education.

At pre-intervention phase baseline information on the 8 variables of knowledge of team building

were collected. This consisted of respondents that heard of team in healthcare, those that heard of

inter-professional team composition, those that defined team building, those that defined inter-

professional team building to involve different professionals , source of information of team

building in health healthcare, those that defined a team, those that knew knowledge

competencies to possess to be an effective team member. The knowledge of team building

among health workers at pre-intervention phase in the study and control groups for the seven

variables showed that respondents for appropriate responses were more than 50% for the two

groups except for variable of sources of information on team building where respondents that

preferred health publications were 57.3% and 6.8% for study and control groups respectively

while respondents that preferred lectures/ conferences were 19.5 % and 65.1% for study and

control groups respectively. Proportion of respondents with appropriate responses were more in

control group than study group for all variables of knowledge except the variable of definition of

team building. There was also statistical significant difference across all variables as determined

by chi-square test (p<0.01) between the pre-intervention and post-intervention phases of study

group.


than study group for all 7 variables of knowledge except the variable of definition of team

building at pre-intervention phase.


policy on team building knowledge for the three tiers of healthcare delivery in Nigeria.

Keywords: Training, Team building, knowledge, health workers
















Igbokwe I, Ojo I,

REFERENCES

1. Tierney MR. Team building events for staff: Are they just play or do they pay?

An investigation into the evaluation of team building interventions. [Unpublished

dissertation] . University of Glasgow Business School Publications; 2006: 1-89.

2. Federal Government of Nigeria. National Human Resources for Health Strategic

Plan 2008-2012. Federal Ministry of Health Abuja publication , 2007[cited 2012

May 20]: 1-84. Available from

who.int/workforcealliance/countries/Nigeria_HRHStrategicPlan_2008_2012.pdf

3. Oandasan I, Baker GR, Barker K. Teamwork in healthcare: Promoting effective

teamwork in healthcare in Canada. Policy synthesis and recommendations.

Canadian Health Services Research Foundation, 2006 [cited 2012 May 10]: 1-46.

Available from : www.chsrf.ca

4. Lehman U, Van-Damme W, Barten F, Sanders D. Task Shifting : the answer to

the human resources crises in Africa? Human Resources Health.2009; 7: 49.

Available from PMID : 19545398[Pub Med]


5. Callaghan M, Ford N, Schneider H. A Systematic review of task shifting for HIV

treatment and care in Africa. Human Resources Health.2010; 8: 8-9.

6. Ogbimi RI, Adebamowo CA. Questionnaire survey of working relationships

between nurses and doctors in university teaching hospitals in Southern Nigeria.

BMC Nursing.2006; 5: 2. Doi : 10. 1186/1472-6955-5-2. Available from : http://

www.biomedcentral.com/1472-6955/5/2

7. Adeniji FO. Groupthink among health workers: The Nigerian Perspective .

Research Journal.2012; 2(5): 1-4. Available from

http://www.sciencepub.net/researcher/research 0205/01_0880_research 0205_1-

4.pdf

8. Iyang US. Interprofessional conflict in Nigeria health care system. Nigerian

Journal of Health Planning and Management. 2007; 3 : 47-50.

9. Ogbimi RI. Career development: the unexplored source of job satisfaction in the

Nigerian health care delivery system. Journal Nig Inst Mgt. 2007; 38: 23-33.

10. Sweet SJ, Norman IJ. The nurse-doctor relationship: a selective literature review.

J of Adv Nursing. 2005; 22: 165-170.

11. Health Nairaland Forums. Why the professional rivalry and disharmony among

medical and health workers? 2012 May 11[cited 2012 October 2 ]:20 .Available

from http://www.nairaland.com/935694/why-professional-rivalry-disharmony-

among

12. Alubo SO. The political economy of doctors strike in Nigeria: a maxist

interpretation. Soc Sc Med. 2008; 22: 467-477.

13. Institute of Health Service Administration of Nigeria at the 2007 National

Conference/ General Meeting and National workshop. In J inst. 2007; 3(1): 45-46.






14. Abiodun AJ. Patients satisfaction with quality attributes of primary health care

services in Nigeria. J Health Mgt. 2010; 12 (1): 39-59.

15. Leggat SG. Effective healthcare teams require effective team members : defining

teamwork competencies. BMC Health Services Research .2007[cited 2012 May

5]; 7:17 doi: 10.1186/1472-6963-7-17. Available from

http://www.biomedcentral.com/1472-6963/7/17.

16. World Health Organization. World Health report: working together for health.

WHO, Geneva. 2006; 1: 1-237. Available from

www.who.int/whr/2006/whr06_en.pdf

17. Ehiri JE, Oyo-Ita AE, Ayanwu EC, Meremikwu MM, Ikpeme MB. Quality of

child health services in primary health care facilities in south-east Nigeria. Child

Care Health Devt. 2005; 31(2) : 181-191.

18. Aronu CO, Bilesanmi AO, Aronu FI. Measuring the resemblance on knowledge

and attitude of team building activities amongst health workers in Nigeria. Inl J of

Sc and Tech Res. 2013; 2(11) : 2-10.

http://www.who.int/whr/2006/whr06_en.pdf

(M.) INSTITUTING TRAININING ON KNOWLEDGE AND ATTITUDE OF TEAM

BUILDING AMONG HEALTH WORKERS IN TWO FEDERAL TERTIARY HEALTH

FACILITIES IN SOUTHERN NIGERIA.

ABSTRACT:


healthcare system generally. The aim of this study was to institute training on team building on

the attitude of health workers in two federal tertiary health facilities in Nigeria.

Methods This was a quasi-experimental study carried out between November 2013 and February

2014. Multistage sampling technique was used to select a total of 242 subjects from ten

categories of professionals of study group (Nnamdi Azikiwe University Teaching Hospital) and

control group (Federal Medical Centre). The study consisted of a pre-intervention, intervention

and post-intervention phases. The training intervention instituted used a mix of conceptual

framework of the Health Belief Model and others. During the intervention phase , training on

team building was successfully conducted in three days for study group. At post-intervention

phase, data from each site was analyzed separately and the results were compared. In conclusion,

team building was well received on knowledge and attitude of health workers in healthcare in the

study tertiary health facility .





1. Department of Community Medicine, Nnamdi Azikiwe University Teaching

Hospital , Nnewi, Anambra State, Nigeria.

2. Department of Surgery, Nnamdi Azikiwe University Teaching Hospital,


3. Department of Internal Medicine, Nnamdi Azikiwe University Teaching


4. Department of Nursing Services, Nnamdi Azikiwe University Teaching


5. Cashville Group of Companies and Partners, worldwide (25 inter-dependent

firms).


7. Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University

Teaching Hospital, Nnewi, Anambra State, Nigeria.

8. Department of Statistics, Nnamdi Azikiwe University, Awka Campus, P.M.B.

5001, Awka , Anambra State, Nigeria.

9. Department of Community Medicine, University of Benin Teaching Hospital,

Benin City, Edo State, Nigeria.

10. Department of Community Medicine, University College Hospital, Ibadan,

Oyo State, Nigeria.

11. Department of Community Medicine and Primary Health, Lagos University

Teaching Hospital, Lagos State, Nigeria.











tertiary health facilities.














At pre-intervention phase baseline information on the 15 variables of knowledge and attitude of

team building were collected. This consisted of respondents that heard of team in healthcare,

those that heard of inter-professional team composition, those that defined team building, those

that defined inter-professional team building to involve different professionals , source of

information of team building in health healthcare, those that defined a team, those that knew

knowledge competencies to possess to be an effective team member, those that believed team






disagree.





compared. The results showed there was statistical significant difference in 10 out of the 15

variables between the two groups at pre-intervention phase as determined by chi-square test

(p<0.01). There was statistical significant difference in 13 out of the 15 variables between the

two groups as determined by chi-square test (p< 0.01) at post-intervention phase. The change in

the variables was highest at 92.2 % for respondents that correctly defined team building.





Conclusion: Team building was well received on knowledge and attitude of health workers in

healthcare in the study tertiary health facility .


policy on team building for the three tiers of healthcare delivery in Nigeria.

Keywords: Training, Team building, knowledge, Attitude, health workers
















Igbokwe I, Ojo I.

REFERENCES

1. Tierney MR. Team building events for staff: Are they just play or do they

pay? An investigation into the evaluation of team building interventions.

[Unpublished dissertation] . University of Glasgow Business School

Publications; 2006: 1-89.

2. Federal Government of Nigeria. National Human Resources for Health

Strategic Plan 2008-2012. Federal Ministry of Health Abuja publication ,

2007[cited 2012 May 20]: 1-84. Available from

who.int/workforcealliance/countries/Nigeria_HRHStrategicPlan_2008_20

12.pdf

3. Oandasan I, Baker GR, Barker K. Teamwork in healthcare: Promoting

effective teamwork in healthcare in Canada. Policy synthesis and

recommendations. Canadian Health Services Research Foundation, 2006

[cited 2012 May 10]: 1-46. Available from : www.chsrf.ca

4. Lehman U, Van-Damme W, Barten F, Sanders D. Task Shifting : the

answer to the human resources crises in Africa? Human Resources

Health.2009; 7: 49. Available from PMID : 19545398[Pub Med]

5. Callaghan M, Ford N, Schneider H. A Systematic review of task shifting

for HIV treatment and care in Africa. Human Resources Health.2010; 8:

8-9.

6. Ogbimi RI, Adebamowo CA. Questionnaire survey of working

relationships between nurses and doctors in university teaching hospitals

in Southern Nigeria. BMC Nursing.2006; 5: 2. Doi : 10. 1186/1472-6955-

5-2. Available from : http:// www.biomedcentral.com/1472-6955/5/2

7. Adeniji FO. Groupthink among health workers: The Nigerian

Perspective . Research Journal.2012; 2(5): 1-4. Available from

http://www.sciencepub.net/researcher/research 0205/01_0880_research

0205_1-4.pdf





8. Iyang US. Interprofessional conflict in Nigeria health care system.

Nigerian Journal of Health Planning and Management. 2007; 3 : 47-50.

9. Ogbimi RI. Career development: the unexplored source of job satisfaction

in the Nigerian health care delivery system. Journal Nig Inst Mgt. 2007;

38: 23-33.

10. Sweet SJ, Norman IJ. The nurse-doctor relationship: a selective literature

review. J of Adv Nursing. 2005; 22: 165-170.

11. Health Nairaland Forums. Why the professional rivalry and disharmony

among medical and health workers? 2012 May 11[cited 2012 October

2 ]:20 .Available from http://www.nairaland.com/935694/why-

professional-rivalry-disharmony-among

12. Alubo SO. The political economy of doctors strike in Nigeria: a maxist

interpretation. Soc Sc Med. 2008; 22: 467-477.

13. Institute of Health Service Administration of Nigeria at the 2007 National

Conference/ General Meeting and National workshop. In J inst. 2007;

3(1): 45-46.

14. Abiodun AJ. Patients satisfaction with quality attributes of primary health

care services in Nigeria. J Health Mgt. 2010; 12 (1): 39-59.

15. Leggat SG. Effective healthcare teams require effective team members :

defining teamwork competencies. BMC Health Services

Research .2007[cited 2012 May 5]; 7:17



SUPPLEMENTAL MATERIALS :

SUPPLEMENTAL MATERIALS

CONTENTS/ CURRICULUM OF TRAINING AND TRAINING METHODOLGY

Intervention phase:

Detail of Intervention: Content/ Scope of Training on Knowledge of ,attitude towards and

practice of team building for quality healthcare

A. Venue: Conference hall of NAUTH, Nnewi (Alternative plan: Rotary Hall or the Clinical

Sciences building classroom of NAUTH).

B. Participants Attendance for training/Grouping into ‘training activity teams’:

Intervention group of 121 participants shall be divided into two sets A and B of 60 participants

and 61 participants respectively, with each set of sets A or B participants attending three (3)

training sessions. Each session lasted for one (1) hour. That is, a total of 6 sessions was

conducted for a total of 6 hours. From each participant set of 60 members set A or set B of 61

members, each participant randomly chose numbers from 1 to 10 to be self-selected into any of

the 6 interprofessional teams (made up of different professionals) that was formed for purpose

of group activities/exercises participation during training sessions. That is, each of the 6 teams

had 10 (or 11) members, with a total of 60 (or 61) members for each of the two sets of

participants.

C. Duration of training: A total of 6 sessions was conducted for about 6 hours in three days.

D. Materials and Methods of training. Overhead slide projector, flip chart/ board and markers,

wall charts, personal computer, power-point printouts of training content, card-board papers

bearing names of fruits for classroom practicum/exercise.

Methods include Socratic Method of lecture (interactive), verbal and non-verbal communication,

visual communication (visual aids), demonstrations and role play.

E. Channels of communication:

A combination of

Interpersonal (oral face-to-face communication by researcher)

Mass media (overhead projector display, personal computer, power-point printed

leaflets , flip charts and wall charts on training content, card-board papers bearing names

of fruits for classroom practicum/exercise ).

F. Set ground rules for training

All hand sets to be in vibration mode or switched off during the training

No chorus answer in response to question(s)

No participant shall be shouted down when responding to question

No side talks with fellow participants to avoid distraction of the training session

Hand should be raised up when seeking for audience to have the floor/permission

G. Introduce Learning Objectives of training .

At the end of this training participants should be able to:

Session I (Day 1):

i. Define a team and Team building and list advantages of team work in healthcare.

ii. List and explain the knowledge competencies required for effective teamwork.

iii. List and Imbibe the proper attitudes towards teamwork.

Session II (Day 2) :

iv. List and explain effective methods for conducting team meetings and for conflict

resolution.

v. Understand and apply problem-solving technique skills by participating in a classroom

practicum / Activity 1: ‘Seek your team member to solve your problem’. Tool and

Method: Names of fruits are written on card board papers that are neatly cut out

(‘disfigured’) into parts that are randomly collected among participants. Each participant

will seek for the complete ‘whole fruit name’ by identifying participants with completing

parts, to make the fruit name complete when parts are arranged together.

Session III (Day 3)

vi. List and imbibe the communication techniques that encourage effective teamwork.

vii. Appreciate common challenges of communication and learn conflict resolution skills

by participating in a classroom practicum/ Activity 2 (Role play) :

Tool and Method: patient/family members that brought him/her (‘staggering’) versus

healthcare providers. Teams take turns, either as patient/family members or the

healthcare providers, to demonstrate challenges of communication.

H. Definition of a Team and Team building and Advantages in healthcare:

A team could be defined as a collection of individuals who are interdependent in their

tasks, who share responsibility for outcomes, who see themselves and who are seen by

others as an intact social entity embedded in one or more larger system and who manage

their relationships across organisational borders.

Team building could be defined as the process of helping a work group become more

efficient in accomplishing its tasks and in satisfying the needs of the group member

Advantages of working in teams (participants to list)

I. Knowledge Competencies of Team building for healthcare:

Examples of knowledge competencies which each team members are to possess include:

Case /care management ; Clinical knowledge; Management knowledge;

Organisational goals and strategies; Organisational politics; Roles of team members

Self-awareness; Team development ;Understanding individual persons(emotional

intelligence) ;

Others (participants to specify)..............................

J. Attitude to Team building for healthcare:

Assertive behaviour; Cooperative attitude; Courage to disagree; Encourage

others ;Facilitates participation; Interpersonal relations;

Self-directed learning Judgement ;Extrovert Personality ;Self-confidence;

Sense of humour; Team work experience; Tolerant of stress;

Others (participants to specify) ……………………….

K. Effective Methods for Conducting team meetings

Five distinct stages of development that can be clearly defined by observation of the

behaviour within group: forming, storming, norming , performing and adjourning.

Another method is PACER. PACER provides a method for conducting team meetings. It

is an acronym for purpose, agenda, code of conduct, expectations, roles and

responsibilities.

L. Effective Methods for conducting team meetings

(Checklist for well-functioning teams)

Purpose: team mates proudly invest in accomplishing the task

Priorities: team mates are convinced about what to do and work towards achieving it

Roles: team mates are clear of who is leading the group and everybody feels part of the

process

Decisions: decision-making lines (informal) are clearly understood and accepted

Personal abilities: team mates feel that their contributions are valued and utilised

Group rules (ground rules): established together, followed through and respected by team

mates

M. How to Communicate effectively ( and Conflict Resolution)

Effective communication uses Emotional Intelligence to avoid conflict

Emotional Intelligence means fully developing and applying emotional and social skills

Using improved skills to positively influence our facility and community

N. How to communicate effectively (Emotional Intelligence)

Emotional Intelligence is needed by everybody in contact with people

Knowing yourself; Maintaining control

Reading others; Perceiving accurately; Communicating with flexibility

O. Role play on importance of Effective Teamwork through communication/conflict

resolution techniques ( group work in teams)

Dr. ‘ABC’/caregiver group and Patient ‘XYZ’ /family members (5 minutes per team

demonstration).

After demonstration by facilitator and research assistants, the 7’ different teams‘shall take

turns to do the role play.

P. Lessons Learnt from the Role play(plenary session)

Common team problems

Communication – bad listening & lack of understanding

Lack of appreciation of each team member

Review of training expectations (listed by each participant)

Q. Conclusion of training/ light refreshment: Closing remarks/ acknowledgement by

the researcher.

(N.) MEASURING THE EFFECT OF TRAINING ON TEAM BUILDING ON THE

KNOWLEDGE AND ATTITUDE OF HEALTH WORKERS IN A STUDY FEDERAL

TERTIARY HEALTH FACILITY IN SOUTH-EASTERN NIGERIA.

ABSTRACT:

Team building has been found to improve the effectiveness and efficiency of resources in the

healthcare system generally. The objective of this study was to measure the effect of training on

team building on the attitude of health workers in two federal tertiary health facilities.

The materials and methods utilized were a quasi-experimental study. Multistage sampling



Centre). The study consisted of a pre-intervention, intervention and post-intervention phases. At

pre- and post-intervention phases, data from each site was analyzed separately and the results

were compared. There was statistical significant difference in 13 out of the 15 variables between

the two groups as determined by chi-square test (p< 0.01) at post-intervention phase.

Conclusively, team building was effective in improving knowledge and attitude of health

workers in healthcare in the study tertiary health facility .





1. Department of Community Medicine, Nnamdi Azikiwe University Teaching

Hospital , Nnewi, Anambra State, Nigeria.

2. Department of Surgery, Nnamdi Azikiwe University Teaching Hospital,


3. Department of Internal Medicine, Nnamdi Azikiwe University Teaching


4. Department of Nursing Services, Nnamdi Azikiwe University Teaching


5. Cashville Group of Companies and Partners, worldwide (25 inter-dependent

firms).


7. Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University

Teaching Hospital, Nnewi, Anambra State, Nigeria.

8. Department of Statistics, Nnamdi Azikiwe University, Awka Campus, P.M.B.

5001, Awka , Anambra State, Nigeria.

9. Department of Community Medicine, University of Benin Teaching Hospital,

Benin City, Edo State, Nigeria.

10. Department of Community Medicine, University College Hospital, Ibadan,

Oyo State, Nigeria.

11. Department of Community Medicine and Primary Health, Lagos University

Teaching Hospital, Lagos State, Nigeria.











tertiary health facilities.

Methods: This was a quasi-experimental study carried out between November 2013 and

February 2014. Multistage sampling technique was used to select a total of 242 subjects from ten

categories of professionals of study group (Nnamdi Azikiwe University Teaching Hospital,

NAUTH Nnewi) and control group (Federal Medical Centre , FMC Asaba) with 121 subjects in

each group. The study consisted of a pre-intervention, intervention and post-intervention phases.

Subjects participated in the study using same self-administered questionnaire for study and

control groups at pre-intervention and post-intervention (three months interval) phases. The

training intervention instituted used a mix of conceptual framework of the Health Belief Model

and others.





At pre-intervention phase baseline information on the 15 variables of knowledge and attitude of

team building were collected. This consisted of respondents that heard of team in healthcare,

those that heard of inter-professional team composition, those that defined team building, those

that defined inter-professional team building to involve different professionals , source of

information of team building in health healthcare, those that defined a team, those that knew

knowledge competencies to possess to be an effective team member, those that believed team






disagree.





compared. The results showed there was statistical significant difference in 10 out of the 15

variables between the two groups at pre-intervention phase as determined by chi-square test

(p<0.01). There was statistical significant difference in 13 out of the 15 variables between the

two groups as determined by chi-square test (p< 0.01) at post-intervention phase. The change in

the variables was highest at 92.2 % for respondents that correctly defined team building.






than study group for all 7 variables of knowledge except the variable of definition of team

building at pre-intervention phase. Proportion of respondents with appropriate responses were

more in control group than study group for all 8 variables of attitude at pre-intervention phase.

Team building was effective in improving knowledge and attitude of health workers in

healthcare in the study tertiary health facility .


policy on team building for the three tiers of healthcare delivery in Nigeria.

Keywords: Measuring, Training, Team building, health workers
















Igbokwe I, Ojo I.

REFERENCES

1. Onyekwere LA. Interprofessional collaboration and work efficiency in secondary healthcare

delivery system in Rivers State. Intl J of Sc Res in Educ. 2013; 6(1):9-46.

Available from www.ijsre.com/vol.6_1_-onyekwere

2. Bradford R. Obstacles to collaborative practice. Journal of Nursing Mgt. 2009; 20: 721-

729.

3. Hope JM, Lugassy DM, Meyer R, Jeanty F, Meyers SP. Bringing Interdisciplinary and

multicultural team building to health care education: The Downstate Team building

Initiative. Academic Medicine. 2005; 80(1): 74-83

4. West African Postgraduate College of Pharmacists .Communiqué of the 23rd Annual

General Meeting and Scientific Symposium of the West African Postgraduate College of

Pharmacists ; 2011 Mar 14-18 ; Shehu Musa Yar’Adua Centre , Abuja, Nigeria. West

African J of Pharmacy. 2012 [cited 2012 June 2012]; 23(1):1-2. Available from:

http://www.google.com/ng/search?

q=interprofessional+team+building+in+Nigeria+health+sector

5. Coster S, Norman I, Murrells T, Kitchen S, Meerabeau E. Interprofessional attitudes

among undergraduate students in the health professions: A longitudinal questionnaire

survey. International J of Nursing studies.2008; 45: 1667-1681.

6. World Health Organization. Being an effective team player. No date [cited 2012 May 6]:

1-22 . Available from http://www.who_mc_topic_topic-4

7. Mikan S, Roger S. Characteristics of effective teams: A literature review. Austr Health

Rev. 2010[cited 2012 May 10]; 23(3) : 201-208. Available from

http://www.aushealthcare.com.au/publication/article details.asp?aid=350.

8. Salas E, Diaz-Granados D, Weaver SJ, King H. Does Team training work? Principles for

healthcare. Academic Emergency Medicine.2008: 15: 1002-1009.

http://www.aushealthcare.com.au/publication/article

http://www.who_mc_topic_topic-4/

http://www.google.com/ng/search?q=interprofessional+team+building+in+Nigeria+health+sector

http://www.google.com/ng/search?q=interprofessional+team+building+in+Nigeria+health+sector

http://www.ijsre.com/vol.6_1_-onyekwere

9. Major S. Dysfunctional teams: A Health and Resource warning. Nursing

Management.2008; 9(2): 25-28.

10. Leach SL, Myrtle RC, Weaver FA. Surgical Teams: role perspectives and role dynamics

in the operating room. Health Services Management Research. 2011; 24(2) :281-290.

SUPPLEMENTAL MATERIALS:

CONTENTS/ CURRICULUM OF TRAINING AND TRAINING METHODOLGY

Intervention phase:

Detail of Intervention: Content/ Scope of Training on Knowledge of ,attitude towards and

practice of team building for quality healthcare

A. Venue: Conference hall of NAUTH, Nnewi (Alternative plan: Rotary Hall or the Clinical

Sciences building classroom of NAUTH).

B. Participants Attendance for training/Grouping into ‘training activity teams’:

Intervention group of 121 participants shall be divided into two sets A and B of 60 participants

and 61 participants respectively, with each set of sets A or B participants attending three (3)

training sessions. Each session lasted for one (1) hour. That is, a total of 6 sessions was

conducted for a total of 6 hours. From each participant set of 60 members set A or set B of 61

members, each participant randomly chose numbers from 1 to 10 to be self-selected into any of

the 6 interprofessional teams (made up of different professionals) that was formed for purpose

of group activities/exercises participation during training sessions. That is, each of the 6 teams

had 10 (or 11) members, with a total of 60 (or 61) members for each of the two sets of

participants.

C. Duration of training: A total of 6 sessions was conducted for about 6 hours in three days.

D. Materials and Methods of training. Overhead slide projector, flip chart/ board and markers,

wall charts, personal computer, power-point printouts of training content, card-board papers

bearing names of fruits for classroom practicum/exercise.

Methods include Socratic Method of lecture (interactive), verbal and non-verbal communication,

visual communication (visual aids), demonstrations and role play.

E. Channels of communication:

A combination of

Interpersonal (oral face-to-face communication by researcher)

Mass media (overhead projector display, personal computer, power-point printed

leaflets , flip charts and wall charts on training content, card-board papers bearing names

of fruits for classroom practicum/exercise ).

F. Set ground rules for training

All hand sets to be in vibration mode or switched off during the training

No chorus answer in response to question(s)

No participant shall be shouted down when responding to question

No side talks with fellow participants to avoid distraction of the training session

Hand should be raised up when seeking for audience to have the floor/permission

G. Introduce Learning Objectives of training .

At the end of this training participants should be able to:

Session I (Day 1):

viii. Define a team and Team building and list advantages of team work in healthcare.

ix. List and explain the knowledge competencies required for effective teamwork.

x. List and Imbibe the proper attitudes towards teamwork.

Session II (Day 2) :

xi. List and explain effective methods for conducting team meetings and for conflict

resolution.

xii. Understand and apply problem-solving technique skills by participating in a classroom

practicum / Activity 1: ‘Seek your team member to solve your problem’. Tool and

Method: Names of fruits are written on card board papers that are neatly cut out

(‘disfigured’) into parts that are randomly collected among participants. Each participant

will seek for the complete ‘whole fruit name’ by identifying participants with completing

parts, to make the fruit name complete when parts are arranged together.

Session III (Day 3)

xiii. List and imbibe the communication techniques that encourage effective teamwork.

xiv. Appreciate common challenges of communication and learn conflict resolution skills

by participating in a classroom practicum/ Activity 2 (Role play) :

Tool and Method: patient/family members that brought him/her (‘staggering’) versus

healthcare providers. Teams take turns, either as patient/family members or the

healthcare providers, to demonstrate challenges of communication.

H. Definition of a Team and Team building and Advantages in healthcare:

A team could be defined as a collection of individuals who are interdependent in their

tasks, who share responsibility for outcomes, who see themselves and who are seen by

others as an intact social entity embedded in one or more larger system and who manage

their relationships across organisational borders.

Team building could be defined as the process of helping a work group become more

efficient in accomplishing its tasks and in satisfying the needs of the group member

Advantages of working in teams (participants to list)

I. Knowledge Competencies of Team building for healthcare:

Examples of knowledge competencies which each team members are to possess include:

Case /care management ; Clinical knowledge; Management knowledge;

Organisational goals and strategies; Organisational politics; Roles of team members

Self-awareness; Team development ;Understanding individual persons(emotional

intelligence) ;

Others (participants to specify)..............................

J. Attitude to Team building for healthcare:

Assertive behaviour; Cooperative attitude; Courage to disagree; Encourage

others ;Facilitates participation; Interpersonal relations;

Self-directed learning Judgement ;Extrovert Personality ;Self-confidence;

Sense of humour; Team work experience; Tolerant of stress;

Others (participants to specify) ……………………….

K. Effective Methods for Conducting team meetings

Five distinct stages of development that can be clearly defined by observation of the

behaviour within group: forming, storming, norming , performing and adjourning.

Another method is PACER. PACER provides a method for conducting team meetings. It

is an acronym for purpose, agenda, code of conduct, expectations, roles and

responsibilities.

L. Effective Methods for conducting team meetings

(Checklist for well-functioning teams)

Purpose: team mates proudly invest in accomplishing the task

Priorities: team mates are convinced about what to do and work towards achieving it

Roles: team mates are clear of who is leading the group and everybody feels part of the

process

Decisions: decision-making lines (informal) are clearly understood and accepted

Personal abilities: team mates feel that their contributions are valued and utilised

Group rules (ground rules): established together, followed through and respected by team

mates

M. How to Communicate effectively ( and Conflict Resolution)

Effective communication uses Emotional Intelligence to avoid conflict

Emotional Intelligence means fully developing and applying emotional and social skills

Using improved skills to positively influence our facility and community

N. How to communicate effectively (Emotional Intelligence)

Emotional Intelligence is needed by everybody in contact with people

Knowing yourself; Maintaining control

Reading others; Perceiving accurately; Communicating with flexibility

O. Role play on importance of Effective Teamwork through communication/conflict

resolution techniques ( group work in teams)

Dr. ‘ABC’/caregiver group and Patient ‘XYZ’ /family members (5 minutes per team

demonstration).

After demonstration by facilitator and research assistants, the 7’ different teams‘shall take

turns to do the role play.

P. Lessons Learnt from the Role play(plenary session)

Common team problems

Communication – bad listening & lack of understanding

Lack of appreciation of each team member

Review of training expectations (listed by each participant)

Q. Conclusion of training/ light refreshment: Closing remarks/ acknowledgement by

the researcher

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