Gross motor function classification system family questionnaire: validating Yoruba-Nigerian version

Background Assessment of the functional abilities of children with cerebral palsy would be more reliable if care givers are included. An instrument commonly used for assessing functional abilities in CP by their caregivers is the Gross Motor Function Classification System Family Questionnaire. No Nigerian Version of this instrument is currently available; hence this study was designed to evaluate the criterion- related validity of the Yoruba (Nigerian) version of the GMFCSFQ among care givers of children with cerebral palsy.Method Fifteen primary caregivers of children with CP, who are fluent in speaking, reading, and writing both English and Yoruba Languages, were purposively sampled from among those bringing their children or wards for physiotherapy at the University College Hospital Nigeria and involved in this study. The participants completed within one week interval, the English and Yoruba versions of the GMFCSFQ by choosing one of the five ordinal levels corresponding to the gross motor function of their children. Spearman’s correlation coefficient was used to examine the relationship between the scores from the English and the Yoruba versions of the instrument. Significant level was set at ά=0.05.Results A strong positive and significant correlation was obtained between the English and Yoruba Versions of the GFMCSFQ (ρ=0.89, p=0.00).Conclusion This suggests that the Yoruba version of the GMFCSFQ is a valid version of the original (English) version. It could therefore be used to gather information about the gross motor function of children with cerebral palsy from their family members or caregivers among Yoruba speaking people of West Africa and in Diaspora.Key words: Cerebral Palsy, Gross Motor Function, Yoruba

Self-motivation, functional ability and participation among stroke survivors’ resident in Ibadan Metropolis, Nigeria

Background: Stroke is a leading cause of death both globally, and in Africa. The attendant effect of the stroke is disability, loss of function and psychosocial issues. Studies have been carried out on different rehabilitation outcomes such as participation, self-motivation and functional ability related to stroke survivors. There is however a dearth of studies exploring the relationships among self-motivation, functional ability and participation of stroke survivors, particularly in our African community.Objectives: Relationship among participation, self-motivation and functional ability of stroke survivors residing in Ibadan was investigated.Methods: This was a cross-sectional survey which involved 44 consenting stroke survivors. Clinical and demographic information were documented. Self-motivation, functional ability and participation of the stroke survivors were assessed with the Self-Motivation Inventory, Fugl-Meyer Assessment of Motor Recovery after Stroke; and London Handicap Scale respectively. Data was analysed with descriptive statistics and inferential statistics of Spearman Rank Correlation at p= 0.05.Results: There was a statistically significant positive correlation between the time since onset of stroke scores and participation (p= 0.02) and between the stroke survivors‘ functional ability and participation scores (p=0.001). Conversely there was no significant relationship between the participants‘ functional ability and time since onset of stroke scores (p= 0.62), between stroke survivors‘ self-motivation and time since onset of stroke scores (p= 0.41), between self-motivation and participation (p=0.80) and between self-motivation and functional ability scores (p= 0.80)Conclusions: Whereas self-motivation appeared non-related to functional ability and participation, a more exploration of the subject matter is still necessary for a conclusive inference to be drawn, especially in view of the sample size involved in this present study. French title: Auto-motivation, capacite fonctionnelle et participation chez les survivants d'avc residant dans la metropole d’Ibadan au Nigeria &nbsp

Test-retest reliability of IPAQ environmental- module in an African population

<p>Abstract</p> <p>Background</p> <p>There is overwhelming evidence of the benefits of physical activity and the physical environment is increasingly recognized as a promising determinant of physical activity participation. The influence of the environment on physical activity has not been evaluated among black Africans and no specific measure exists for assessing environmental factors related to physical activity in an African environment. The IPAQ E- module was designed to assess environmental factors for physical activity participation and was considered to be relevant to all countries regardless of the stage of economic development. The objective of this study was to assess the test- retest reliability of IPAQ E- module in an African population.</p> <p>Methods</p> <p>One hundred and three clinical students of a University in Nigeria were invited to participate in the reliability testing of IPAQ E- module. Sixteen of the 17- items on the environmental measure were assessed for test- retest reliability using intraclass correlation coefficient (ICC) with 95% Confidence interval (CI) overall and by gender. The measure addressed items regarding residential density, access to destinations, neighborhood infrastructures, aesthetic qualities, social environment, street connectivity and neighborhood safety.</p> <p>Results</p> <p>Of the total respondents, 51.5% were males and 48.5% were females. Overall, the intraclass correlation coefficient (ICC) ranged from 0.43 to 0.91. The item regarding many interesting things to look at (aesthetic) produced the overall highest reliability score (ICC = 0.91, 95% CI = 0.86 – 0.94), while the item regarding safety from crime during the day (neighborhood safety) produced the lowest overall score (ICC = 0.43, 95% CI = 0.26 – 0.57). Reliability of items on neighborhood infrastructures ranged between substantial agreement to almost perfect agreement overall (ICC = 0.66 – 0.88) and by gender (male- ICC = 0.68 – 0.90 and female- ICC = 0.63 – 0.86). The access to destination items (ICC = 0.49 – 0.74), social environment (ICC = 0.62) and street connectivity (ICC = 0.78) all had acceptable reliability overall. Meaningful differences were found between males and females on two items on neighborhood safety and one item on access to destinations.</p> <p>Conclusion</p> <p>The test- retest of IPAQ E- module resulted in moderate to almost perfect agreement for most of the items with few meaningful differences by gender. Environmental items of physical activity in an African population exhibited reliability similar to that in other environments. These results suggest that IPAQ E- module may be a useful measure for assessing environmental correlates of physical activity among population in Africa.</p

E-DEMOCRACY: A REQUIREMENT FOR A SUCCESSFUL E-VOTING AND E- GOVERNMENT IMPLEMENTATION IN NIGERIA

ABSTRACf Reducing poverty by 50% through the use of information and communication technology (ICT), which is the primary objective of the millennium development goals (MDGs) requires a lot of innovations such as the implementation of e-Government, e-Democracy, e-Learning, e-Voting, eJudiciary, and e-Health to mention but a few. Participatory democracy is a major requiremer1t for achieving the MDGs, particularly, where majority of the citizenry is disenchanted with the electioneering or democratic processes or governance. This paper reviews the rate of ICT diffusion and the global ranking of the e-Government initiatives of some African countries. The paper also presents the Nigerian National IT policy, the general views of some randomly selected electorates concerning e-Voting, the voting pattern in the past elections, and the likely motivating factors for eVoting in the country as well as the necessary requirements that will facilitate the successful implementation of both e-Voting and e-Government initiatives. Similarly, the paper presents a model for e-Democracy implementation for increased trust and participation in government. Findings revealed that the apathy between electorates and government arose from lack of trust, probity, transparency and accountability. Although, a reasonable percentage of the respondents supported to the adoption of e-Voting, it is equally evident from the level of diffusion of IT facilities: Internet and telephone, that there is still need for improved infrastructure. The position of Nigeria in Africa and the world on global e-Government ranking is abysmally low and does not justify the enormity of material and human resources available in the country. For a successful adoption of eVoting and e-Government, grassroot mobilization through e-Democracy should be encouraged. Government should as a matter of urgency look into the inadequate basic infrastructures that stimulates ICT diffusion and encourage interaction between the electorates and the elects through the adoption of e-Democracy, which in turn encourages probity, transparency, accountability and participation in governance

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

The Nigerian e-Government Strategies (NeGST)

Nigeria has made frantic efforts towards achieving the millennium development goals (MDGs) as spelt out in the United Nations’ Agenda for the world. A critical assessment of the e-Government strategies in Nigeria is important being responsible for 20% of the population of the entire African continent. This paper presents a review of the e-Government strategies in Nigeria; the human capital development initiatives; the information and communications technology (ICT) diffusion and e-Inclusion. The global and continental ranking of the country is presented as well as recommendations to accelerate developments towards achieving the MDGs. Findings revealed that there are ongoing efforts in Nigeria to address the issue of poverty. The various initiatives of government include: the National/State Economic Empowerment Strategies (NEEDS/SEEDS), the Vision 2020, the National e-Government Strategy (NeGST) and a well-formulated National IT policy to mention a few. The little hindrance encountered in the research is that the available data was only up to the year 2005 and 2006 in some cases. However, based on the human capital development indices such as: economic empowerment and poverty reduction, education, health, employment generation, etc, it was observed that the adult literacy level of 64.2% is satisfactory and better results are expected before 2015. The life expectancy level is constant (54 years) from 2002 to 2007, which is the one of the lowest in Africa. On school enrolment, the major problem is access and poverty. It was observed that only 25% of primary school leavers made it to the secondary school level, while about 14% of the students at this level made it to the tertiary level. Similarly, the average percentage of female enrolment in schools is 45%. The health facilities are under-funded and are grossly inadequate both in quality and quantity. There is an average of 1,700 persons per hospital bed and the ratio of physicians to the populace is about 1:6000. This calls for a state of emergency in this sector. One major sector of the economy that is experiencing a boost is the ICT and Telecoms. The sector had brought about a teledensity growth of 0.73 to 37.05 from 2001 to 2007. Consequently, Nigeria has been named the fastest growing Telecoms nation in Africa and the third in the world, with a number of direct and indirect jobs created. Similarly, the rate of Internet diffusion is encouraging bearing in mind that the level was almost nonexistent in 1999. It is obvious that Nigeria would be able to bridge the divide by 2015. Generally, there are some meaningful developments in the country arising from the various poverty eradication schemes but the resultant effect has not imparted positively on unemployment. This is the opinion of the populace and hence the need for government to restrategize, otherwise, fulfilling MDGs by 2015 may not be realistic.</jats:p

IMPACT OF MOTOR DEVELOPMENT IN CHILDREN WITH CEREBRAL PALSY ON THE QUALITY OF LIFE AND GENERAL HEALTH STATUS OF CAREGIVERS

Cerebral Palsy (CP) is a neuropaediatric condition which occurs as a result of damage to an immature brain resulting in abnormal motor development requiring special care. Caring for children with CP may affect the quality of life and/or impact on the general health status of their caregivers. There is paucity of longitudinal studies exploring this inter-relationship. The relationship between motor development of Children With Cerebral Palsy (CWCP) and impact of caring on each of Quality of Life (QoL) and General Health Status (GHS) of caregivers of CWCP was therefore evaluated. Participants in this longitudinal study comprised of consecutively recruited 107 CWCP and 107 Caregivers of CWCP (CCWCP) from four specialist hospitals in southwest Nigeria. Ninety eight caregivers of normally developing children were also recruited to constitute the Control Group (CG). The CCWCP and CG were matched for age and socio-economic status. However 67 participants in each of the CWCP, CCWCP, and 87 in the CG completed the study. Gross motor function of the CWCP was assessed in the clinic and their respective homes using the Gross Motor Function Measure (GMFM)(scored 0 to 100) at baseline and monthly for eight consecutive months in order to assess the likely influence of the home and the clinic environments on their motor function. The QoL and GHS of the CCWCP and CG participants were assessed at baseline and for eight consecutive months using the World Health Organization Quality of Life Questionnaire (WHOQoL) (scored 1 to 5) and General Health Questionnaire (GHQ)(scored 0 to 3) respectively. Data were analyzed using descriptive statistics, Wilcoxon Signed Rank, Friedman's ANOVA, Spearman's Correlation and Mann-Whitney U at p = 0.05. At baseline, the CCWCP had a significantly lower median WHOQoL score of 84.0 (range 48.0-115.0) than their CG counterparts (median 96.0, range 62.0-123.0). CCWCP also recorded a significantly higher median GHQ score of 16.0 (range 4.0'48.0) than the controls (median 9.0, range 1.0-22.0) indicating lower QoL and GHS. At the 8th month, the CG had significantly higher WHOQoL scores (median 96.0, range 63.0-124.0 vs median 89.0, range 60.0-118.0). Among the CWCP, baseline GMFM score was higher at home (median 15.7, range 0-71.9) than in the clinic (median 13.6, range 0-71.9). Similarly the home GMFM scores were significantly higher at the 8th month (median 28.9, range 0-100.0) than in the clinic (median 25.8, range 0-100.0). The GMFM score increased significantly between baseline and 1st; 3rd and 4th; 5th and 6th; and 7th and 8th months. The GMFM scores had significant positive correlation with WHOQoL scores at the 5th (r = 0.3), 7th (r =0.4) and 8th months (r =0.4). The better the motor development in children with cerebral palsy, the higher the quality of life and general health status of caregivers. Performance of motor function was better at home compared to the clinic suggesting that home environment should be simulated during management of children with cerebral palsy