Background Adequate Human Resources for Health is indispensable to achieving Universal Health Coverage and physicians play a leading role. Nigeria with low physician–population ratio, is experiencing massive exodus of physicians. This study investigated emigration intention of physicians, the factors influencing it and discussed the implications to guide policy formulation and reforms, curtail the trend and safeguard the country’s health system. Methods Through cross-sectional survey, 913 physicians from 37 States were interviewed with semi-structured questionnaire using Google form shared via WhatsApp and Telegram forums of Nigeria Medical Association. Data were analysed with IBM-SPSS version-25 and charts were created with Microsoft-Excel. Chi-square and multiple regression tests were done with p-value set at 0.05. Results The mean age of respondents is 37.6 ± 7.9 years; majority of them are males (63.2%), married (75.5%) with postgraduate qualifications (54.1%) and working in public health facilities (85.4%). Whereas 13% and 19.3% are, respectively, satisfied with their work and willing to continue practice in Nigeria, 43.9% want to emigrate and 36.8% are undecided about future location of their practice. The commonest reasons for emigration are poor remuneration (91.3%), rising insecurity (79.8%) and inadequate diagnostic facilities (61.8%). Physicians working in public health facilities are 2.5 times less satisfied than their counterparts in non-public sector (AOR = 0.4; 95% CI = 0.3–0.8). Physicians in their thirties, forties and fifties are 3.5 (95% CI = 1.5–8.0), 5.5 (95% CI = 2.1–14.5) and 13.8 (95% CI = 3.9–49.3) times, respectively, more willing to retain practice in Nigeria than those younger and those satisfied with their work are 4.7 (AOR = 4.7, 95% CI = 2.9–7.4) times more willing to practice in Nigeria than those not satisfied. Conclusion Majority of Nigerian physicians want to emigrate for professional practice and top among the push factors are poor remuneration, rising insecurity and inadequate diagnostic facilities. The observed trend portends danger to the country’s health system due to the foreseeable negative consequences of physician deficit to the system. We recommend upward review of physician remuneration, a root cause analysis of insecurity to determine workable preventive measures and increased funding of the health sector to improve the diagnostic infrastructure, retain physicians and save the health system from imminent collapse.
Background The rate of diagnostic testing for malaria is still very low in Nigeria despite the scale-up of malaria rapid diagnostic test (MRDT) availability, following WHO's recommendation of universal diagnostic testing in 2010. We investigated whether a social group sensitisation and education intervention (social group intervention) and a social group intervention plus health-care provider training intervention would increase the demand (use or request, or both) for MRDTs among community members in Ebonyi state, Nigeria. MethodsWe did a three-arm, parallel, open-label, stratified cluster-randomised controlled trial in Ebonyi state, Nigeria, to evaluate the effects of two interventions compared with a control. We randomly assigned geographical clusters that were accessible (close to a road that was drivable even during the rainy seasons) and had at least one eligible public primary health facility and patent medicine vendor (those that offered MRDT services) in a 1:1:1 allocation to the control arm (receiving no intervention), social group arm (receiving sensitisation and education about MRDT), or social group plus provider arm (receiving the social group intervention plus provider training in health communication about MRDT). Investigators, participants (social groups, providers, respondents), and interviewers could not be masked to group assignments. The primary outcome was the proportion of children younger than 5 years with fever or malaria-like illness, in the 2 weeks preceding a household survey, who received an MRDT, and the coprimary outcome was the same outcome but among children aged 5 years and older (ie, up to and including 17 years) and adults (excluding pregnant women). The outcomes were measured at an individual level via household surveys before the interventions and 3 months after the end of the interventions. All analyses were done using a cluster-level method on an intention-to-treat basis. This trial is registered with ISRCTN, number ISRCTN14046444. FindingsWe carried out eligibility screening and recruitment of participants (clusters, social groups, and providers) between July 2 and Sept 27, 2018. 34 clusters met the eligibility criteria and 18 were randomly selected to participate and randomly assigned to arms (six clusters per arm). A mean proportion of 40•6% (SD 14•5) of eligible children younger than 5 years in the control arm received an MRDT, versus 66•7% (11•7) in the social group arm (adjusted risk difference [aRD] 28•8%, 95% CI 21•9-35•7, p<0•0001) and 71•7% (19•8) in the social group plus provider arm (aRD 32•7%, 24•9-40•5, p<0•0001), with no significant difference between the social group arm and the social group plus provider arm. A mean proportion of 36•3% (18•5) of eligible children aged 5 years and older in the control arm received an MRDT, versus 60•7% (14•0) in the social group arm (aRD 25•6%, 16•8-34•4, p=0•0004), and 59•5% (18•3) in the social group plus provider arm (aRD 28•0%, 19•5-36•5, p=0•0002), with no significant difference between the social group arm and the soci...
Background A good understanding of the demand for malaria rapid diagnostic test (MRDT), malaria health care-seeking behavior, and drug use among community members is crucial to malaria control efforts. The aim of this study was to assess the demand (use and/or request) for MRDT, health care-seeking behavior, and drug use, as well as associated factors, among rural community members (both children and adults) with fever or malaria-like illness in Ebonyi state, Nigeria. Methods A cross-sectional household survey was conducted between October 1st and November 7th, 2018, in 18 rural geographical clusters. Data was collected using a structured interviewer-administered questionnaire. Descriptive analysis was done using summary statistics. Associated factors (socio-demographic, knowledge and opinion level) were assessed using bivariate and multivariate binomial logistic regressions while the overall effects of these factors were assessed using the “postestimation test” command in Stata. Results A total of 1310 children under 5 years of age and 2329 children ages 5 years and above and adults (excluding pregnant women) (3639 overall) participated in the study. Among the 1310 children under 5 years of age: 521 (39.8%) received MRDT of which the caregivers of 82 (15.7%) requested for the MRDT; 931 (71.1%) sought care with public/private sector providers (excluding traditional practitioners/drug hawkers) the same/next day; 495 (37.8%) sought care at government primary health centres, 744 (56.8%) sought care with the patent medicine vendors (PMVs); 136 (10.4%) sought care with traditional practitioners; 1020 (77.9%) took ACTs (=88.2%, 1020/1156 of those who took anti-malarial drugs). Generally, lower values were respectively recorded among the 2329 children ages 5 years and above and adults (excluding pregnant women). The most important overarching predictor of the demand for MRDT and care-seeking behaviour was the knowledge and opinion level of respondent female heads of households about malaria and malaria diagnosis. Conclusions Among the rural community members with fever or malaria-like illness in Ebonyi state, Nigeria, while majority did not receive MRDT or diagnostic testing, and sought care with the PMVs, most took anti-malaria drugs, and mostly ACTs. Interventions are needed to improve the knowledge and opinion of the female heads of households about malaria and malaria diagnosis.
We describe the techniques applied by the University of Alberta (UA) team in the most recent Competition on Legal Information Extraction and Entailment (COLIEE 2021). We participated in retrieval and entailment tasks for both case law and statute law; we applied a transformer-based approach for the case law entailment task, an information retrieval technique based on BM25 for legal information retrieval, and a natural language inference mechanism using semantic knowledge applied to statute law texts. This competition included 25 teams from 14 countries; our case law entailment approach was ranked no. 4 in Task 2, the BM25 technique for legal information retrieval was ranked no. 3 in Task 3, and the natural language inference technique incorporating semantic information was ranked no. 4 in Task 4. The combination of the latter two techniques on Task 5 was ranked no. 2. We also performed error analysis of our system in Task 4, which provides some insight into current state-of-the-art and research priorities for future directions.
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