Evaluation of the capacity of Pediatricians in Nigeria to conduct of research: A nationwide Survey

Background Quality health care service delivery to children and adolescents is enhanced by continuous research into the health challenges of this subpopulation led by paediatricians with tremendous capacity to investigate and proffer solutions to the myriads of childhood illnesses. Understanding the health issues therefore is the foundation for implementation of viable interventions that assure optimum service delivery. In view of this background, the Paediatric Association of Nigeria (PAN) directed that research into children’s health challenges in Nigeria should be brought to the front burner in the country. Pursuant to this laudable goal this study was conceived to evaluate the research capacity and capability of paediatricians in Nigeria and the institutions they represent. In view of above needs, this study aimed at evaluating the research capacities and challenges among paediatricians. Methods The survey used a cross-sectional nationwide design to enroll paediatricians into the study. The study was a combination of both online and face-to-face survey using questionnaire developed from Research Capacity Assessment Framework. Information on previous research work, challenges encountered, existing capacity and utilization of research outcome were obtained. The SPSS version 20 was used for data entry and analysis. For qualitative variables, similar responses were grouped under thematic heading. Results The response rates for online (via email survey, group-administered in a conference and individual face-to-face (at workshops) were 32 (3.2%), 75 (13.6%) and 15 (60%) respectively. The majority, 87(85.5%) of the participants had conducted prevalence studies, compared to 9 (8.8%) that had done experimental studies. Those who have ever received grant funding for their studies were 21 (19.4%), while the proportion whose research outcome had informed policy update and practice were policy 20 (18.2%). More than 55% of the participants had challenges on some of the seven aspects of research: research topic, proposal, funding, fieldwork, analysis, utilizing findings and collaboration. Less than 40% of the participants had received training on some of the tested 14 research capacity areas except for the area of ethics where 78 (70.9%) reported having received training. For 51 (46.4%) this ethics training included the Good Clinical Practice Guidelines. Conclusion Nigerian Academic Paediatricians need to be stimulated to develop interest in research by building their presently low research capacity if future paediatric practice is to be driven significantly by evidence.

Quality health care service delivery to children and adolescents is enhanced by continuous research 23 into the health challenges of this subpopulation led by paediatricians with tremendous capacity to 24 investigate and proffer solutions to the myriads of childhood illnesses. Understanding the health 25 issues therefore is the foundation for implementation of viable interventions that assure optimum  It is the responsibility of paediatricians among other child advocates and stakeholders around the 3 world to ensure optimal wellbeing of every child. This is to be achieved through their involvement 4 in these five inter-related domains of practice: clinical service and consultancy, research, 5 education/teaching, clinical leadership and clinical service planning and management. 1 The 6 benefits to child healthcare service delivery can be improved if human resources are allocated 7 effectively to cover all these domains. However, in reality, this does not appear to be the case. 8 One domain that suffers the most is clinical research. The fact remains that the entire deliverables 9 in paediatric care can be greatly enhanced if informed by evidence-based approaches. 10 Paediatricians are exceptionally well positioned to lead in this effort because of both their 11 specialization and positioning to utilize these evidenced-based clinical practice guidelines to 12 improve child health care. This is possible if the health research is designed to address key clinical 13 needs and resolve knowledge gaps in order to provide practical and implementable solutions. 2

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Clinical research is fundamental in health care delivery system. When the research is carried out 15 in a goal-oriented manner with clear view of expected outcome, is expected to propel continuous 16 improvement in the disposition of healthcare workers to towards service delivery. Such efforts 17 should be rewarded especially where the outcomes has significant impact on clinical practice by 18 closing knowledge gaps. 2

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Although several studies have cited lack of support systems for research, increased clinical 20 workload, 3 lack of funds, and the high premium placed on clinical service and consultancy as  The first step in the process is a need assessment to determine the existing and spread of research 8 capacities among paediatricians in Nigeria. Using a SWOT analysis (strength, weakness, 9 opportunities and threat) approach based on the research capacity assessment framework the study 10 aims to evaluate the paediatricians' clinical research engagements, challenges, and capacities to 11 undertake meaningful research. This paper reports the preliminary findings on research capacities 12 of paediatricians in a nationwide survey.     The data was double entered into SPSS version 20 software. Frequencies were calculated for 2 discrete variables, while means and standard deviation were calculated for continuous variables.

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The qualitative data was reviewed and categorized under thematic headings.

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The Questionnaires retrieval rate for online, conference, and workshop were 32 (3.2%), 75 (13.6%) 6 and 15 (60%). The extra 17 questionnaires were obtained from regional survey. A total of 117 7 questionnaires were obtained, 7 incomplete questionnaires were excluded and 110 were finally   14 Thirty (28.6%) of the participants representing the majority were general paediatricians ( Figure   15 2). Responses from the regions are shown in figure 3. 16 Table   3 2 for complete details.
4 The list of challenges in descending order starting with the most challenging were getting sponsor    To determine area that will require capacity development, respondents were asked to enlist 2 research related trainings they had received. The least received trainings were data quality 3 assurance (7.3%), and team science (8.2%) (  The majority of the research works carried out by paediatricians were prevalence studies. Although  instructional activities for which more paediatricians had received training. These trainings place 7 paediatricians at vintage position to lead or be part of experimental study involving children. 8 The reported high prevalence of lack of access to grants is a disturbing factor to be urgently 9 addressed failure of which will militate against conduct of high quality research targeted at importance of this is highlighted by our finding that paediatricians were engaged in low quality 15 research that does not feed into policy updates. 16 Evidence have shown that the expected outcome of any research work is to generate evidence that 17 will change policy and practice. [20][21][22][23] Unfortunately this study revealed that most of the studies 18 carried out by paediatricians have not fulfilled this role. It appears that previous research efforts 19 were not targeted at needs of children and adolescent. The driving force for research in the Nigeria 20 includes academic pursuit and promotion for the academic paediatricians. The country must now 21 move on to tailor research to the needs of children and adolescents. The real needs of children and 22 adolescents have to be clearly identified and targeted by research. This way paediatricians will be 23 exposed to the concept of targeted research for evidence that will inform policy improvement and 1 practice (GRIPP). 24 To achieve this goal there are basically two broad strategies to be employed: 2 engaging the stakeholders is one and using evidence in decision making is the another. 21 The sole 3 goal of GRIPP is to achieve knowledge translation, knowledge transfer, knowledge exchange, 4 research utilization, implementation, diffusion, and dissemination. 25 The translation of research 5 findings into actionable policy and programmatic guidance is an achievable goal to be exploited. 6 The study has shown that there is lack of strategic research capacity building in the country. It has 7 always remained a point of argument; can clinicians be effective researchers? Beyond an obvious 8 yes, a conscious and adequate capacity development is urgently needed. The capacity development 9 should be ongoing through an organized structure that will enable and support programmes that  Lack of funding showed up strongly as a rate limiting step to conduct research by the respondents. 19 The research component of the residency programme in Nigeria is poorly funded. There is also 20 limited national funding arrangement for academic paediatricians to compete for. In order to 21 respond to these concerns, capacity building programmes should receive high priority in health Paediatricians need to be stimulated to develop interest in research by building their presently low 16 research capacity if the future paediatric practice is to be driven significantly by evidence.

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Paediatricians in Nigeria should be re-orientated to aggressively contribute to evidence-based 18 practice by seeking to build their own capacity for high quality research and to demand strong 19 support for research into children and adolescents' health concerns in Nigeria. This will pave the 20 way for programing of priority intervention for capacity building.