Factors Affecting the Practice of Routine Medical Examination by Health Professionals in a Tertiary Health Center

INTRODUCTION

Routine medical examination (RME) is a form of preventive measure involving thorough history, physical examination, and screening of asymptomatic persons by physicians on a regular basis as part of a routine healthcare process.^[1] Over the ages, RME has served as the avenue for promoting health care system engagement, early disease detection, management, and preventive screening of asymptomatic adults.^[2] These RMEs include but are not limited to breast examination, mammography, papanicolaou (PAP) smear for cervical cancer screening, fasting blood glucose, blood pressure checks, visual and dental examination, etc. Historically, the practice of RME began in the 1920s as a response to outbreaks of epidemics like tuberculosis and the Black Plague and an increasing need for screening into professional bodies and institutions. RME can be done on preschool admission, pre-employment staff, as well as periodically during schooling and employment years, for the purpose of early detection and prompt treatment of disease.

People around the world pay varying levels of attention to health issues and give different levels of priority to medical checkups.^[3] Health care providers (medical doctors, nurses, midwives, physician assistants, laboratory scientists, and primary health care providers) are amongst the most knowledgeable persons, in respect to RME, taking into consideration their professions, but studies have found that this knowledge does not always translate into the uptake of RME among this group.

In a study on factors affecting routine medical screening among health workers in Delta State University Teaching Hospital, Ogahara, of the 297 participants surveyed, the rating of the practice of RME was good (26.2%) and poor (73.7%).^[4]

The paucity of information regarding the factors affecting the practice of RME among health care providers in the State brings to the fore the need for this research.

It is no news to state that there have been several cases of avoidable sudden deaths reported among health care workers, some of which can be linked to the lack of routine preventive medical examinations that could have led to the early detection and treatment of underlying illnesses or diseases, thereby preventing the incidence of sudden deaths. This poor uptake of RME by health care professionals has greatly affected the healthcare delivery system due to the loss of valuable, skilled health care workers in an already depleted supply of needed health manpower. There is therefore, need to further educate and enlighten healthcare providers who themselves play major roles in providing health education for the public on the availability and need for RME.

Little attention seems to be placed on the importance of RME in clinical practice; nonetheless, globally, RME has come to be accepted as a very important determinant of the health status of the population. Screening healthy populations for diseases is highly advantageous because diseases are more successfully treated if detected early, and treatment can be instituted on time.

In a resource-limited country like Nigeria, the usefulness of RME in early detection of diseases cannot be overemphasized as it improves the quality of life, saves costs on extensive medical care, and generally reduces morbidity and mortality. In a 2021 health indices ranking, the life expectancy at birth for Nigeria was 55.12 years. Life expectancy at birth for Nigeria was seen to have increased from 41.21 years in 1971 to 55.12 years in 2021.^[5] Although this may be considered a huge improvement, it is still very low compared to the life expectancy seen in other countries of the world, with Nigeria ranking as the second lowest in the world, topping only Lesotho.^[5]

In Cross River State, Nigeria, where a similar study was conducted, there are several health care facilities, ranging from the University of Calabar Teaching Hospital, General Hospital, Federal Neuro-psychiatric hospital, the Navy Reference Hospital, private hospitals and several primary health centers; however, no study has been conducted on the factors affecting the practice of RME among health care providers in the State.

It is worth noting however that a previous study carried out on the knowledge, attitude and practice of routine medical check-up among health care workers in a tertiary health facility in Calabar, Nigeria, the results showed that majority, 295 (92.8%) of the respondents had good knowledge of routine health check-up, with most of them 205 (64.5%) expressing positive attitude towards routine health check-up, less than half of them 147 (46%) practiced routine health check-up.^[3] However, did not explore the factors contributing to this suboptimal practice, which informed the need to explore this dimension.

Health care providers have the required training and responsibility for administering this examination and tests on patients or those who consult them, so it is often taken for granted that they themselves would carry out this exercise; however, it has been observed that this high level of knowledge of RME among health care workers is not in tandem with its practice. Many factors can be said to contribute to this dilemma, which include but may not be limited to the presumed knowledge of RME, the professional workload of patient care, practice size, specialty, availability of proper screening centers, health insurance coverage, and even the unconscious overconfidence of most health care providers.

There is general reluctance or a feeling of apathy among health care providers to undergo RME. Most health care providers see it only as a pre-employment requirement, which ends after one has undergone the initial examination. After the initial medical check, the majority of health care providers do not bother to undergo the periodic medical examination, even for as long as they remain employed, until they retire, with concomitant incidents of sudden deaths.

The aim of this study is to assess the factors affecting the practice of RME among healthcare professionals in the University of Calabar Teaching Hospital, Cross River State, Nigeria.

MATERIAL & METHODS

The study was conducted in the University of Calabar Teaching Hospital, Calabar, in Cross River State, Nigeria. The Teaching Hospital was established in 1979 at the former St. Margaret Hospital at Moore Road, in Calabar South Local Government Area. It was later relocated to its present site in the Calabar Municipal Local Government in February 2012. The facility provides specialist clinical services and serves as a referral center for primary, secondary, and private hospitals for residents of Calabar and its environs. It also provides undergraduate, postgraduate, and residency training programs for students at the University of Calabar Medical College and interested staff, serving as a center for human development and advancement of research. The health facility is a large structure comprising various health service rendering departments and administrative units.

This was a cross-sectional descriptive study, and the study population was both male and female members of the University of Calabar Teaching Hospital, Calabar, who gave their consent to participate in this study. The minimum sample size, “n” (was calculated using the Cochran formula), was 341.

A multistage sampling was used to select participants for the study.

The first stage involved stratifying the existing 65 departments into seven departments using simple random sampling by balloting.

The second stage comprised the selection of two units from each department using simple random sampling by balloting. Proportionate allocation was applied to each unit.

In the third stage, a simple random sampling technique (by balloting) was also employed to select participants from each unit until the required minimum sample size was attained.

The final study sample comprised 66 Doctors, 105 Nurses, 38 Radiographers, 33 Medical Laboratory Scientists, 24 Pharmacists, 23 Medical Records Staff, and 52 Medical Health Assistants. A total sample size of 341 was obtained for this study.

Data collection was done using a pretested and validated self-administered, semi-structured questionnaire adapted from a previous study on RME.^[6] Pretesting of the questionnaire was done for validity and reliability using healthcare providers working in a Private Diagnostic Health Facility in Calabar, Cross River State, Nigeria.

The questionnaire was manually sorted, coded before the entry of the data. The data were analyzed using the IBM Corporation statistical package for social sciences (SPSS) version 21.0 and were summarized and presented using frequency tables, bar charts, and pie charts. Mean and standard deviation were calculated for continuous variables, while categorical variables were expressed using frequencies and percentages. Data were then summarized using tables and figures. Associations were done using the Chi-square test and Fisher’s exact test for cell count less than 5. The level of statistical significance was set at 5% (p < 0.05).

Ethical clearance was obtained from the Research Ethics Committee of the University of Calabar Teaching Hospital. Informed consents were obtained from the respondents and were informed appropriately on the purpose and content of the exercise, and were assured of anonymity and confidentiality of any information provided. Written consent was obtained from all participants before the commencement of data collection.

RESULTS AND DISCUSSION

The majority, 135 (37.4%) of the respondents were between the ages of 30 to 39 years, with a mean age of 37.35±8.5. A larger proportion, 192 (53.2%), of the respondents were females; 350 (97.0%) were Christians, 353 (97.8%) had tertiary education as their highest qualification, the majority, 185 (51.2%), were non-clinical staff; and 154 (42.7%) were Efiks, as shown in Table 1

The ages of the respondents range from 21-60 years, with the mean age of respondents being 35.86 ± 8.97 years. A higher proportion of respondents were 31-40 years of age (41.9%), females 209 (61.3%), married 171 (50.1%), Efiks 102 (29.9%). With regards to the professionals, nurses constituted the highest proportion, 105 (30.8%), as shown in Table 1.

For factors that hinder respondents from practicing RME, out of 341, the majority, 203 (59.5%), cited lack of insurance coverage, which was followed by heavy workload, 146(42.8%), and the expensive nature of some RME tests, 146 (42.8%), as shown in Table 2.

Factors which encourage practice of RME among respondents, the majority did RME because they were concerned about their health, 295 (86.5%), while others did RME as part of a pre-employment requirement, 265 (77.7%), as shown in Table 3.

DISCUSSION

This study was aimed at assessing the knowledge, practice, and factors associated with RME among healthcare providers in the University of Calabar Teaching Hospital. Most studies that have been conducted on this subject were done among the general population, on specific cadres of health workers, or on specific types of RME. Among our respondents, the most commonly cited hindrances to their practice of RME were a lack of National Health Insurance Agency (NHIA) coverage, heavy workload, and the tests being too expensive. This is probably because healthcare providers usually have a heavy workload, which might prevent them from creating time to embark on RME. Some respondents, however, opined that since they had no obvious signs or symptoms of illness, they did not see the need for the RME; this is more so due to their perceived phobia of being given a diagnosis from the result of the RME, which they are scare of knowing, but will rather leave with the illness rather than know about it through RME.

Similar sentiments of lack of time and high cost of RME tests were equally cited as hindrances to the practice of RME in a study among traders in Ghana.^[7] In a related study among health workers in Sokoto, Northwest Nigeria, most of the respondents said they felt well and therefore did not see the need to carry out periodic medical exams; in addition, the fear of the unknown also prevented them from practicing RME in another similar study.^[8] These findings are in contrast to those found among members of a community in Southwest Nigeria, where the most prevalent reason was that they were not sick. This disparity is because the respondents in the Southwest study were community members with generally lower knowledge of RME and its importance.^[6]

Most respondents, who practiced RME, did so because they were concerned about their health; this is similar to the reasons given by elderly people in a study in Riyadh, Saudi Arabia.^[9] Also, most respondents undertook the RME as part of their pre-employment requirement, which was never done again throughout their active years in service, until they finally retired from active service. The need for the creation of awareness by health authorities of the usefulness of RME as a life-saving and cost-saving practice also came to the fore in our study. The policy makers can make RME certificates acquisition and presentation a prerequisite for staff to present during promotion interviews, and a condition for them to be promoted. The Management of these healthcare facilities should create a work environment that can run shifts so that they can have time to do scheduled periodic medical examinations, while ensuring that the costs of the tests are pocket-friendly to their staff and are covered by NHIA.

CONCLUSION

Our study showed that factors which hindered our respondents from practicing RME were: lack of RME coverage in NHIA, heavy worker load, and high cost of some RME tests. As important as these findings are, they will help the management to consider subsidizing RMEs for her staff as a way of improving the practice of RME, reducing the prevalence of sudden deaths at work workplace, as well as maintaining the increased rate of a healthy workforce for greater productivity.

The recommended doctor-to-patient ratio according to the WHO is 1:600; however, the doctor-to-patient ratio in Nigeria falls far below the global recommendation, being 4:10,000.^[10] This has been attributed to the increasing rate of migration of Doctors and other healthcare providers out of the country. It has become imperative that preventive medicine becomes the bedrock of patient care in Nigeria to minimize the patient load presenting at the hospital, as well as reduce the workload of health care workers, thereby affording them more time for personal practice of RME.