Demography and Medical Education among Nigerian Final Year Medical Students-Implication for Regional and Human Resource Development

Objective: This study examined the influence of demography such as gender, age, marital status and religion on medical education among final year medical students in different geopolitical zones of Nigeria. Methods: This is a cross sectional descriptive study that drew a total of seven hundred and fifty seven (757) final year medical students from ten (10) randomly selected fully accredited medical schools out of a total of twenty seven (27) fully accredited medical schools in Nigeria. Demographic information was obtained from the medical students following completion of their final year postings. Results: The total population of female final year medical students was 300 (39.6%) and 457 (60.4%) for males. The minimum and maximum ages were 19 and 42 years respectively with a mean age of 25.30 ± 2.90 year. Seventy (9.2%) of the 757 final year medical students were married, while 687 (90.8%) were still single. The religion distribution revealed 181 (23.9%) of the final year medical students to be practicing Islam. Five hundred and seventy five (76.0%) of these students practice Christianity and only 1 (0.1%) of the students practices traditional religion. Conclusion: The findings have implication for policy formulation to reduce inequalities observed in medical education in Nigeria.


Introduction
Nigeria is a country in Sub-Saharan Africa, occupying the West Africa region. It has an estimated population of over 160,000,000 [1]. The predominant tribes of Hausa-Fulani, Yoruba and Igbo occupied the North-East/North-West, South West and South East regions respectively [1]. The map of Nigeria showing distribution of the three major ethnic groups without the minority ethnic groups constituents is shown in Figure 1. Nigeria consists of thirty six (36) States and a Federal Capital Territory (FCT), Abuja. For ease of regional and political administration, Nigeria is divided into six (6) geopolitical zones or regions. These geopolitical regions include the North-East (Yobe, Borno, Bauchi, Gombe, Adamawa and Taraba States). This region is presently affected by 'Boko Haram' Insurgency and temporary closure of schools providing western education from primary to tertiary level is a common finding. How this 'Boko Haram' concept literally translated to mean "western education is evil", will affect medical education and other forms of western education in the next few years in this region is unclear.   Nigeria population, though diverse in nature, in terms of ethnicity, culture, religion and languages, it is divided into predominantly Islamic Northern region, and predominantly Christian Southern region with intersperse of few traditional religion practitioners cutting across the two regions [1].
Marriage in traditional Islamic societies has been known to be early in life, especially among women whom are often married in their teens [2,3]. This is often a contrast among individuals and societies that practice Christianity and some other religions. Early marriage has also been known to put a constraint on education and economic development among young women [2,3].
Gender inequality characterized many professional practices worldwide, with a wider inequality gap often observed in most African and traditional Islamic countries [1]. The gender inequality is also observed in medical profession in most parts of the world [6], including African countries where the inequality gap is likely to be wider.
It is unclear how demography presently influences medical education in Nigeria and most Sub-Saharan African countries. This study examined the influence of demography such as gender, age, marital status and religion on medical education among final year medical students in Nigeria.

Methods
The locations of the study are five out the six geopolitical zones of Nigeria. Nigeria, for ease of political and regional administration is divided into six geopolitical zones, thirty six States and one Federal Capital Territory ( Five out of the six geopolitical zones of the country with a total of ten (10) randomly selected medical schools, out of a total of twenty seven (27) fully accredited medical schools in Nigeria [8] were involved in the study. Two fully accredited medical schools were randomly selected from each of the five geopolitical zones, making a total of 10 fully accredited medical schools. The random selection of the ten medical schools led to 9 States participating in the study.
Therefore, a total of ten (10) fully accredited medical schools selected from nine (9) States and five (5)  The ten fully accredited medical schools that participated in the study included:

Ethical Consideration
Ethical approval for this study was obtained from the Institutional Review Board (IRB) of Federal Neuropsychiatric Hospital, Enugu, Enugu State, Nigeria.

Procedure
The Questionnaires for this study were sent to Consultant Psychiatrists affiliated with each of these fully accredited medical schools in Nigeria. The data were collected from the medical students following completion of Psychiatry postings in their final year.

Results
A total of seven hundred and fifty seven (757) final year medical students drawn from ten (10) fully accredited medical schools across Nigeria were involved in the study. This gives an average of about 76 final year medical students per medical school.

Sex and age distribution
The total population of female final year medical students was 300 (39.6%) and 457 (60.4%) for males final year medical students. The minimum and maximum ages were 19 and 42 years respectively. The mean age is 25.30 ± 2.90 year. The median and mode ages were both 25 years.

Sex and age distribution according to the geopolitical zones
Sex and age distribution according to the geopolitical zones are shown in Table 1. The gap in gender disparity or inequality is wider in the North Central and South East zones, whereas the gap was almost non-existent in the South West and South-South zones. The disparity in gender representation among the final year medical students, when all the zones are combined is statistically significant (X2=13.29, df=4, p=0.01), with male gender dominating the female gender. The gender distribution according to the geopolitical zones is also reflected in Figure 3.

Marital status and religion distribution
Seventy (9.2%) of the 757 final year medical students were married, while 687 (90.8%) were still single. The religion distribution revealed 181 (23.9%) of the final year medical students to be practicing Islam. Five hundred and seventy five (76.0%) of these students practice Christianity and only 1 (0.1%) of the students practices traditional religion. The marital status and religion distributions are shown in Table 2.

Marital status and religion distribution
Seventy (9.2%) of the 757 final year medical students were married, while 687 (90.8%) were still single. The religion distribution revealed 181 (23.9%) of the final year medical students to be practicing Islam. Five hundred and seventy five (76.0%) of these students practice Christianity and only 1 (0.1%) of the students practices traditional religion. The marital status and religion distributions are shown in Table 2.

Marital status and religion distribution according to the geopolitical zones
Highest proportion of married final year medical students is from the North West zone. The disparity in marital status of the final year medical students is statistically significant (X2=45.64, df=4, p=0.00), with the larger proportion of the medical students in each of the five geopolitical zones more likely to be single. The marital status distribution according to geopolitical zones is shown in Figure 4.
North Central (NC) and South West (SW) revealed a mixture of Islam and Christianity as religions of practice among the students, but with predominance of Christianity, 80.2% and 78.9% for NC and SW respectively. South-South (SS) zone revealed 100% predominance for Christianity, while the South East (SE) zone showed 99.4% predominance for Christianity. Only the North West (NW) zone showed a predominance of Islam (91.0%) compared to other religions. The difference in religious practices among the studied final year medical students is statistically significant (X2=418.34, df=8, p=0.00), with most final year medical students more likely to practice Christianity. The religion distribution according to the geopolitical zones is shown in Figure 5.

Discussion
The mean age of the final year medical students is about 25 years. The male gender accounted for higher proportion of the population. Most of the final year students are single and majority practice Christianity.