The aim of the study was to examine the relationship between burnout, cardiovascular risk factors and inflammatory markers among a sample of resident doctors in Nigeria. This study adopted a cross-sectional design, and it investigated 203 resident doctors from two tertiary hospitals in Oyo State, South-Western Nigeria. Data on the participants’ sociodemographic characteristics, cardiovascular risk profile, burnout status (using the Maslach Burnout Inventory Human Services Survey tool) were collected. The collected data were analysed using the Statistical Package for the Social Sciences (SPSS) version 23 software. For all tests, a two-sided p-value < 0.05 was considered significant. This study found that dyslipidemia (77.3

BackgroundEarly Career Doctors (ECDs) in Nigeria are faced with many individual and systemic problems, which consequently adversely affect their health, well-being, patient care and safety.ObjectiveThis study, the second phase of the Challenges of Residency Training and Early Career Doctors in Nigeria (CHARTING II) Study, sought to examine the risk factors and contributors to the health, well-being and burnout amongst Nigerian ECDs.MethodsThis was a study of health, well-being and burnout amongst Nigerian ECDs. Outcome variables included burnout, depression, and anxiety, which were respectively assessed using the Copenhagen Burnout Inventory (CBI) and Oldenburg Burnout Inventory (OLBI), Patient Health Questionnaire (PHQ-9) depression scale, and Generalized Anxiety Disorder (GAD-7) scale. The quantitative data obtained was analysed using the IBM SPSS, version 24. Associations between categorical outcome and independent variables were assessed using chi square, with level of significance set at < 0.05.ResultsThe mean body mass index (BMI), durations of smoking and alcohol consumption of the ECDs were 25.64 ± 4.43 kg/m2 (overweight range), 5.33 ± 5.65 years and 8.44 ± 6.43 years respectively. Less than a third (157, 26.9%) of the ECDs exercised regularly. The most common disease conditions affecting the ECDs were musculoskeletal (65/470, 13.8%) and cardiovascular diseases (39/548, 7.1%). Almost a third (192, 30.6%) of the ECDs reported experiencing anxiety. Male and lower cadre ECDs were more likely than female and higher cadre ECDs to report anxiety, burnout and depression.ConclusionThere is an urgent need to prioritize the health and well-being of Nigerian ECDs, so as to optimize patient care and improve Nigeria's healthcare indices.

Background:Many anthropometric measures have been developed in the last two decades to evaluate cardiovascular health and disease. However, the relationship between these measures and blood pressure is not commonly explored among young population. Objective:This study sought to explore the relationship between selected traditional and novel anthropometric metrics and blood pressure among young people as part of ThE profile of anthRopometRy And psyChosocial issuEs on campus (TERRACE) study. Methods:A total of 375 participants were included in the study. Basic demographic details, standard methods were used to measure blood pressure, and anthropometric measures Height, weight, waist circumference, hip circumference, and neck circumference were measured. Derived waist and hip indices included the waist-hip ratio, waist-to-height ratio, weight-adjusted waist index, abdominal volume index, neck-to-height ratio, and conicity index. The linear relationships between the anthropometric parameters and systolic blood pressure, diastolic blood pressure, and pulse pressure were explored. Those that were strongly correlated, moderately correlated, weakly correlated, and effectively uncorrelated were graded 0.50-1.0, 0.30-0.49, 0.10-0.29, and less than 0.10, respectively. The analysis was done using SPSS version 23. A p-value <0.05 was considered significant. Results:The mean age ±standard deviation(SD) and proportion of females were 21.1±3.5 years and 245 (65.3%), respectively. The mean ±SD systolic blood pressure, diastolic blood pressure, and pulse pressure were 109.2 11.2 mmHg, 67.5±8.8 mmHg, and 41.6±11.1 mmHg, respectively. Most of the variables have a statistically significant relationship with the blood pressure parameters; however, all are neither moderately nor strongly correlated. Conclusion:Most of the anthropometric indicators, including the novel ones, are correlated with BP parameters in this young population. However, further research is needed to unravel newer one with better correlations in this population.

Objective: The study assessed the profile and factors associated with fast food consumption among young people in tertiary educational institutions in Ibadan, Nigeria.Materials and Methods: This was a cross-sectional study carried out among 300 eligible undergraduates in four campuses in Ibadan, Nigeria. Socio-demographic characteristics and information on fast food consumption and other relevant data were collected using a self-administered questionnaire. Statistically significant p-value was set at <0.05. SPSS version 23 was used for data analysis.Results: The mean ± standard deviation (SD) age was 21.6 ± 3.7 years and females constituted 66% of the participants. Nine out of ten participants had never married, majority were fulltime students and holiday jobs were noted in less than a third. About three out of five participants consumed fast food, which was usually flour-based. The commonest pattern of fast food consumption was lunch, with the commonest frequencies of once a day and thrice a week. The strongest reasons for consumption include being considered nutritious, being readily available, claiming it provides value for money, and being accessible.Conclusion: Fast food consumption was high in this study and this potentially has serious implications on the cardiovascular health of the participants. There is need for concerted efforts by the relevant stakeholders in stemming this tide by encouraging health education for healthy eating among young persons.

Background:The emergence of COVID-19 had a massive impact on the health system globally. While there are many kinds of literature reporting the impact on postgraduate medical training in other parts of the world, this cannot be said about Nigeria.Methodology:This was a national cross-sectional study among Resident doctors via an online google form survey for 8-months. Stratified cluster design where the entire country was stratified into the six geopolitical zones, and Tertiary Health Institutions (THI) were randomly selected from each of these zones. Data from the 47-item google form were analysed with Statistical Package for Social Science (SPSS) version 23, and internal consistency reliability was measured by Cronbach's alpha coefficient. Categorical variables were compared using chi-square, and the p-value was <0.05.Results:A total of 239 residents from THI in all six geopolitical zones completed the survey. The mean± standard deviation of the age of respondents, years in practice, and years in residency were 36.3±4.4); 10.2±7.6 years, and 4.2±2.6 years, respectively. The Cronbach's alpha coefficient was 0.95. Less than half had delayed the progression of residency (44.4%). The least strongly positive impacts were related to recruitments (4.2%), laboratory testing (4.2%), and ward rounds (4.2%); and the more strongly positive disruptive impact was on postgraduate seminars (9.2%), research (8.4%), professional examinations (8.0%) and residents' clinical schedules (8.0%).Conclusion:COVID-19 has caused a considerable delay in residents' training programs, and resident doctors have great concerns regarding the pandemic. This impact is perceived by them in almost all aspects of the training.

Background:Obesity among the youth is a major public health problem. Globally, the burden of obesity has been on the increase, particularly among young persons, with associated psychosocial issues. This study aimed to present the rationale and design of ThE profile of anthRopometRy And psyChosocial issuEs on campus (TERRACE) Study and as well report some preliminary findings obtained on the anthropometric and psychosocial profile of young persons in some tertiary institutions in Oyo State, Nigeria.Methods:This study first described the methodology of the main study (TERRACE Study) and also provided a report of the preliminary data. The TERRACE study adopted a cross-sectional design of eligible and consenting adults between 16-35 years of age. A three-stage multi-stage sampling technique was used to recruit the participants. Questionnaire, weighing scales, and other tools were used to collect data on socio-demographic, cardiovascular profile, sleep, anthropometric, and psychological variables. Descriptive and inferential statistics were used for data analysis, using SPSS version 23 software.Result:The preliminary data were obtained from 225 participants recruited from three tertiary institutions in Ibadan metropolis, with mean age of 21.5 ± 3.8 years. The majority were females (77.3%) and self-employed, with an average income less than 10,000 naira monthly (less than $25/month at an exchange rate of 400 naira/dollar). The males had higher systolic blood pressure compared to females and constituted a higher proportion of current smokers compared to females (was significant (p < 0.0001 and 0.011 respectively). A fifth (20.4%) of the population were underweight, while overweight and obese people accounted for 12%. They were mostly depressed, (183(87.9%) were moderate to severe depression), more of the females compared to males were anxious.Conclusion:The preliminary results revealed a high burden of underweight, obesity and psychosocial issues among the young people in Ibadan, Nigeria. Further findings to be obtained from the TERRACE Study would enhance the development of an effective public intervention in addressing anthropometric- and psychosocial-related health problems as well as provide baseline data for further studies among this population.

INTRODUCTION Recently, there has been an upsurge in the migration of medical personnel, especially early career doctors (ECDs) from low- and middle-income countries, Nigeria inclusive, to high-income countries with wide-ranging consequences on the social and economic systems of the donor countries. This study assessed the profile and determinants of intention to emigrate by ECDs in Nigeria. METHODS A cross-sectional study conducted among Nigerian ECDs from nine tertiary hospitals. Socio-demographic characteristics, intention & reasons to emigrate and willingness to return were collected using a self-administered semi-structured questionnaire. Data were analysed using Statistical Package for Social Sciences (SPSS) version 23. RESULTS A total number of 763 ECDs participated in the study. The majority (88.2%) were less than 40 years of age and the male to female ratio was 2:1. Majority of the participants (69.4%) received monthly income ≤833 US Dollar. About two-thirds of ECDs had plans to emigrate and most to developed countries. Common reasons for intention to migrate were better quality of postgraduate training, improved quality of life and better remuneration. CONCLUSION High proportion of Nigerian ECDs has intention to emigrate out with potential adverse effect on the fragile health system in the country.

Introduction: Copyrighted Maslach Burnout Inventory (MBI) is perhaps the most widely used and validated tool in assessing burnout among different occupations and health care professionals compared to the free to use Copenhagen Burnout Inventory (CBI) and Oldenburg Burnout Inventory (OLBI). This study aimed to determine the reliability and validity of these tools in comparison with MBI among a subset of Nigerian resident doctors. Methods: A cross-sectional survey with reliability of the burnout scales calculated using Cronbach’s alpha. Construct validity was assessed by principal component analysis and correlating dimensions within each burnout tool with one another using Pearson’s correlation coefficient. The criterion validity of each dimension was assessed for the ability of independent variables to predict their scores using multiple linear regression. Results: Copenhagen Personal Burnout dimension had the highest Cronbach’s alpha score of 0.91. MBI-Emotional Exhaustion had the highest correlations with Copenhagen Work-related, Copenhagen Personal-related, and Oldenburg Exhaustion burnout dimensions. Only the multiple regression models for Copenhagen personal (p = 0.04) and work-related (p = 0.02) burnout dimensions were significant, with the specialty of the residents being the significant independent variable in both models. Conclusion: CBI and OLBI have high internal consistency and reliability among the subset of resident doctors recruited into this study, CBI dimensions had the best predictive and construct validity and can be used as valid alternative to MBI.

Introduction: Job satisfaction and quality of life (QOL) are critical issues among early-career doctors (ECDs) in Nigeria; however, there is a paucity of data on these two issues. This study explored job satisfaction and QOL among ECDs in Nigeria. Methods: It was a cross-sectional study that used a self-administered questionnaire to collect data on sociodemographic and job satisfaction parameters from 667 ECDs in seven Nigerian tertiary hospitals. The World Health Organisation QOL-BREF tool was used to assess their QoL. Results: Results showed that the ECDs were satisfied with their career choice; however, they were not satisfied in the areas of remuneration, workload, and work environment. Furthermore, QOL was fairly above average, with the lowest scores reported in the environmental domain and only a slight male-to-female difference in the physical domain. Conclusion: Clinical practice dissatisfaction among ECDs could negatively impact healthcare service delivery. Therefore, it is recommended that the quality of the workplace environment and infrastructure in society at large should be improved upon by various stakeholders. This will positively impact the QoL of ECDs and enhance optimal healthcare delivery to the nation's teeming population.

The study examined the characteristics and factors driving the acquisition of postgraduate academic degrees among resident doctors in Nigeria. About 10% of the respondents had a form of university postgraduate degree with majority being master's degree. Having more than seven years of professional practice was the only factor predicting the acquisition of postgraduate academic degrees amongst the respondents [AOR: 0.243 (95% CI: 0.069,0.856; p = 0.028)]. The acquisition of postgraduate degree is not common among the surveyed resident doctors; and those that will acquire it do so in the later part of their career.

Purpose/Aims:This research aimed to study the profile, perceptions, barriers, and predictors of Nigerian resident doctors' level of engagement in scientific research.Methods:This study was a descriptive cross-sectional quantitative survey of 438 resident doctors in Nigeria. This study forms a part of the big CHARTING Study, the protocol of which was published in "Nigeria Journal of Medicine 2019;28:198-205."Results:Three hundred and eighteen (72.8%) respondents were male and 119 (27.2%) were female. There were 229 (52.4%) registrars and 208 (47.6%) senior registrars, while residents in surgical versus nonsurgical specialties were 190 (44.5%) and 237 (55.5%), respectively. Three hundred and sixty-eight (85%) respondents had participated previously in research; 67 (15.6%) and 72 (16.6%) had their papers published in local or international journals, respectively; and only 46 (10.6%) had held first authorship positions in peer-reviewed journal publications. The significant barriers to research identified among them included lack of funding, lack of free time, inadequate training/knowledge on research methodology, and the onerous nature of clinical research. The independent predictor of previous engagement with research was years on current job (P = 0.007). This was similar to finding for the first authorship of a peer-reviewed article among the respondents (P = 0.017).Conclusion:This study concludes that publication and grantsmanship rates were very low among the surveyed resident doctors, despite their high rate of engagement in research projects. There is a need for increased research capacity building among resident doctors in Nigeria.

This study explored association between early career doctors (ECDs) duty hours and their quality of life (QoL). Information was collected on socio-demographics, duty hours and QoL of 391 Nigerian ECDs. Results showed median of 70 duty-hours weekly, 10 call-days monthly and 6 sleep-hours daily. Weekly duty-hours and daily sleep-hours were significantly negatively and positively correlated respectively with all four domains of WHOQoL. QoL potentially affects health of ECDs especially mental health. Policies targeted at improving ECDs workforce, working conditions should improve QoL and curtail the potential impact of brain drain and attrition among ECDs in Nigeria.

(1) Background: leadership behaviour is a poorly explored phenomenon among early-career doctors (ECDs). Good leadership is vital in maximising the effective management of patients in a clinical setting. While a good number of studies, though with small sample surveys, have researched the role of leadership in clinical setting quantitatively, qualitative investigations are yet to be done in Nigeria. This study aims to explore the attitudes, skills, and experience of ECDs in Nigeria on issues pertaining to leadership in a medical setting, using a mixed-method approach. (2) Methods: we conducted two sessions of key informant focus group discussion (FGD) that involved 14 ECD leaders in Nigeria, exploring their leadership experience in a clinical setting. Furthermore, we used a self-administered questionnaire to quantitatively survey 474 ECDs from seven Nigerian teaching hospitals to explore their attitudes, skills, and experience on issues pertaining to medical leadership. (3) Results: taking on leadership roles is a common phenomenon (52.7%) among the surveyed ECDs; however, the medical leadership position can be very challenging for ECDs in Nigeria. Despite the fact that many (91.1%) of the surveyed ECDs perceived leadership skills as essential skills needed by a doctr, many (44.1%) of them were yet to be formally trained on medical leadership. About three out of every 10 (23.6%) of surveyed ECDs that have ever held leadership positions in a medical setting experienced major leadership challenges while in such office due to their lack of training on leadership skills. Leadership skill acquisition programmes are highly recommended to become an integral part of medical training programmes in Nigeria. (4) Conclusion: there is a need for a structured leadership skill acquisition programme for ECDs in Nigeria. This programme will help in the robust delivery of highly effective healthcare services in Nigeria, as effective leadership is crucial to patient care services.

Abstract Introduction: Peer learning is an important component of the postgraduate medical curriculum, and it is considered as an integral part of learning in some countries. The practice of peer learning among postgraduate trainees, especially the resident doctors, is an area that has not been explored in Nigeria and other third world countries. This study aims to examine the practice, perception, and drivers of peer-to-peer training in Nigeria. Methodology: This study was a national multi-centre and multi-disciplinary cross-sectional survey, conducted among resident doctors in Nigeria. Semi-structured questionnaires were used to obtain respondents’ biodata, perception and practice on peer learning. Data were analysed using SPSS version 23 software. Results were presented as frequency table and proportion, means, and standard deviation. Inferential statistics such as bivariate analysis was performed. Results: Majority, 287 (73.2%), considered the peer education programme as an appropriate learning practice, 173 (45.9%) considered peer education programme integrated part of the training, while 350/383 (88.2%) engaged in a peer education programme. Statistically, a significant association was found between those who considered peer training as appropriate (p = 0.038) and those who considered peer education as an integral part of postgraduate medical training curriculum (p =0.009). Conclusion: Peer learning is popular among resident doctors in Nigeria. Concerted efforts are needed to re-structure the residency training curriculum in order to maximize the benefits of this learning approach for an effective training programme.

Background: Early career doctors (ECDs) are a dynamic and highly mobile group of medical and dental practitioners who form a significant proportion of the health workforce in Nigeria. The challenges of residency training and ECDs in Nigeria CHARTING Phase I study explored limited challenges affecting ECDs under the broad themes of demography, workplace issues, and psychosocial issues. The CHARTING II was expanded to provide wider insight into the challenges of ECDs in Nigeria. Objective: This protocol aims to provide clear objectives including description of objectives, design, and rationale for the conduct of the proposed CHARTING II study which seeks to explore other components under the various themes of demographic, workplace, psychosocial issues affecting the ECDs in Nigeria, and which were not explored under CHARTING I. Methodology: This shall be a mixed study design that will combine qualitative and quantitative methods, to investigate 27 subthemes among 2000 ECDs spread across 31 centers, accredited by the Nigerian Association of Resident Doctors. Participants shall be selected using the multistage sampling method. The primary data will be generated using structured proforma and validated questionnaires, while administrative sources would serve as a source of secondary data. Data will be entered and analyzed using appropriate statistical software. Conclusion: CHARTING II study would provide more robust data and insight into the problems encountered by ECDs in Nigeria. This would in turn build a platform for institutional engagement and advocacy in order to drive relevant policies to mitigate these challenges.

Abstract Background Early career doctors (ECDs) are faced with many challenges due to their transition from undergraduate medical/dental studentship to being postgraduate doctors and being in an early phase of their career. The specific factors that affect ECDs in their careers and endeavors at the workplace range from poor remuneration, particularly in developing countries, to psychosocial problems (such as burnout [BO] syndrome). There is a dearth of information on BO among ECDs in Nigeria. This qualitative study aims to explore the opinions of ECDs in Nigeria on the causal/predisposing factors of BO, effects of BO, and strategies for mitigating BO among ECDs in Nigeria. Method Using purposive sampling method, two sessions of focus group discussions (FGDs) involving 14 ECDs (key informants) holding key leadership positions and who were delegates of other ECDs in Nigeria were conducted to explore their experiences on psychological issues among ECDs. Data collected were transcribed and analyzed thematically. Results BO is an issue of serious concern among ECDs in Nigeria. The causes of BO are diverse, some of which include low staff strength, prolonged work hours, wrong counseling, lack of job description and specification, and abuse of powers by trainers. In order to mitigate the issue of BO among ECDs, the respondents recommended that work policy review, medical workforce strengthening, stakeholder dialog on ECDs’ welfare, regular psychological review of ECDs, and provision of free yearly medicals need to be looked into. Conclusion: Our findings revealed that the participants considered BO issues among ECDs to be common, and it affected their performance and the overall quality of care in Nigeria health system. Based on our findings, there is an urgent need to mitigate the problem of emotional exhaustion among ECDs in Nigeria.

Objective: Aggressive periodontitis is a disease entity that can be classified as Stages III & IV and Grade C chronic periodontitis based on the 2017 classification of the American Association of Periodontology for periodontal diseases. It is a class of chronic periodontal disease that features clinically severe periodontal tissue destruction. The diagnosis of aggressive periodontitis in this environment is delayed because of some influencing factors such as lack of dental awareness, patients’ poor attitude towards this disease entity and their low socio-economic status. The objective of this case series is to highlight the factors that influence the time of presentation and severity of periodontal tissue destruction of Stages III & IV and Grade C chronic periodontitis (aggressive periodontitis) in this environment. Cases Description: We present the summary of the history, clinical features and radiological findings of four (4) cases of early and delayed presentation of aggressive periodontitis patients aged 19-27 years and factors that influenced their time of presentation. Severe periodontal tissue destruction was a common feature in these four cases with eventual tooth/teeth loss in delayed presenters. They were all treated using standard periodontal debridement with normal saline and 0.2% chlorhexidine gluconate, scaling, root planing and systemic antibiotics therapy. The patients provided informed consents, ethical approval was obtained from the institutional ethical committee and the study was conducted in accordance with the Helsinki declaration of 1975 as revised in 2000. Results: The factors that influenced the time of presentation included dental awareness through dental education, missing and mobile teeth, fear of further loss of teeth in the future, replacement of missing teeth, social marginalization, believe in some traditional ‘taboos’ and socio-economic status. Conclusion: There is a need for aggressive dental education/enlightenment of the people in this environment especially on periodontal disease. Clinical Significance: Dental awareness through dental education generally influenced time of presentation which prevents severe destruction of the periodontium.

Early career doctors (ECDs) are faced with many unique challenges; this is even more pronounced in low resources setting like country Nigeria. To unravel and improve understanding of these challenges the National Association of Resident Doctors of Nigeria (NARD) initiated a trainee driven research initiative. NARD initiated the Research and Statistics Committee (RSC), a six member team derived from her membership. In an attempt to carry out her responsibility efficiently the committee created the Research Collaboration network (RCN), a 43 member team comprising ECDs from across Nigeria. The key themes to be explored under this initiative include demographic, work and psychosocial issues as it affect ECDs in Nigeria. This article is set out to describe in detail the NARD initiative in term of the structure, operational modalities and agenda for the year 2018/19.

Burnout among physicians is a global phenomenon which has been under-reported in middle and low-income economies. The importance of burn-out on the physicians' well-being, patient care and overall health care system cannot be overemphasized. In Nigeria, few studies are specific to burnout, with most of the available studies exploring psychosocial issues at physicians' workplace stress and job dissatisfaction. This present review of literature is assessing burnout among Nigerian Physicians. This review is designed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The review identified observational, review, longitudinal and experimental studies on Nigerian physicians between 1970- 2017, which have the full text in the English language. The articles were searched from online databases such as PUBMED, Directory of Open Access Journals (DOAJ), African Journals Online (AJOL) and Google Scholar by researchers. The keywords used include “Physician”, “Nigeria”, “burn-out” syndrome. The prevalence of 23.6% to 51.7% burnout was reported among physicians in the selected studies, with young age being a strong predictor for burnout. High burden of emotional exhaustion, depersonalization and personal accomplishment were reported in the study carried out among resident doctors who are early career doctors. The prevalence of burnout reported from these studies in Nigeria is very high, although they are within the globally reported range of physician burnout. Nevertheless, there is a dearth of information on the subject matter among Nigerian Physicians. There is a need to carry out more studies on burnout among Nigerian Physicians.Keywords: Burnout, Doctors, Nigeria, Physician