Extent of ICD-11 Implementation in Teaching Hospitals of North-East Nigeria: A Cross-Sectional Survey of Health Information and ICT Professionals

Background: The 11th revision of the International Classification of Diseases (ICD-11) took effect in January 2022, yet there is no published evidence on how far Nigerian hospitals have put it into use. We measured the extent of ICD-11 implementation reported by health information management (HIM) professionals and information and communication technology (ICT) personnel in three teaching hospitals in North-East Nigeria, and examined which respondent and hospital characteristics were associated with substantial implementation. Methods: This was the second objective of a cross-sectional survey of staff in teaching hospitals in Yola, Bauchi and Maiduguri, whose design is described in a companion paper. Twelve Yes/No indicators covering system availability, technical integration, functional readiness and interoperability were summed (range 0-12); a score of 6 or more was defined as substantial implementation. Associations were examined with chi-square tests and binary logistic regression. Results: Data from 475 respondents were analysed (373 HIM, 102 ICT; response 97.7%). A third (32.2%) reported none of the indicators, half (51.2%) reported one to five, and 16.6% (95% confidence interval [CI] 13.6-20.2) reported six or more. Substantial implementation was reported by 20.1% of HIM officers and 3.9% of ICT personnel (p < 0.001), and by 3.8% of respondents in Yola, 31.8% in Bauchi and 10.6% in Maiduguri (p < 0.001). After adjustment, ICT personnel (adjusted odds ratio [AOR] 0.14; 95% CI 0.05-0.42) and staff with 16 or more years of experience (AOR 0.17; 0.06-0.50) were less likely, and staff in Bauchi (AOR 13.57; 4.58-40.19) and Maiduguri (AOR 3.88; 1.25-12.03) more likely than staff in Yola, to report substantial implementation. Conclusion: ICD-11 implementation is at an early stage in these hospitals, with wide differences between professions and hospitals. Joint HIM-ICT planning, integration of the ICD-11 code set into existing systems, training and hospital-specific support are needed. The estimates rest on self-report and a pragmatic cut-off and should be confirmed by audits of actual coding.