Community Health Extension Workers Research Articles

Factors influencing choice of healthcare facilities utilisation by rural households in Ogun State, Nigeria

Abstract Understanding the choice of healthcare facility utilisation is essential to the provision of need-based healthcare services to the population. This study was carried out to estimate factors influencing the choice of healthcare facilities utilised by rural households. A multistage sampling procedure was used to select 240 rural households comprising 1440 persons. Data were collected with the use of a structured questionnaire and analysed with descriptive techniques and a multivariate probit (MVP) model. The MVP result showed that households supplement public healthcare facilities with private clinics, support traditional medical treatment with self-medication, and replace self-medication with public healthcare facilities and private clinics. Similarly, age, gender, household size, cost of drugs, distance to public healthcare facilities, travelling cost, contact with community health workers, total income, awareness of public health facilities, quality of health facilities, and terrain of health facilities influence the choice of healthcare facilities utilised. The study concluded that increased total income, contact with community health extension workers, awareness of health facilities, and perceived quality of services rendered positively influence the choice of healthcare facilities sorted after while the increase in the cost of drugs, distance to health facilities, travelling cost and difficult terrain of health facilities negatively impact the choice of healthcare facilities utilised. The study recommended that public healthcare facilities should be located within the reach of the people and equipped with essential drugs at a reduced cost. Households should also engage in activities that will increase their income so that they can use better healthcare facilities.

Assessment of Utilization of Standing Order in the Management of Patients by Community Health Extension Workers in Ekiti State, Nigeria

Engagement and training of community health extension workers was the strategy adopted by Nigeria to solve the problem of the dearth of skilled health workers at the primary health care level. This group of health workers were trained to use standing orders in the management of the patient at this level of care. The purpose of this study is to investigate the extent of utilization of standing order among community health extension workers. The research was cross-sectional in nature, and it used a self-applied structured questionnaire. The questionnaire was distributed between March and April 2022. There were 265 respondents with age ranges between 23 and 58 years, and the majority (86.7%) were females. 98.1% possessed a copy of the standing order, and 88.5% and 9.9% kept their standing orders in health facilities and home, respectively. 62.3% used it regularly, 19.6% occasionally, 8.3% sometimes and 9.8% rarely used it. Reasons given for not using standing orders included- waste of time, patients who think I am not competent, and not containing new drugs. Regular utilization of standing order is low, and there is a need to educate the community extension workers on the importance of standing order at the primary health care level. Keywords: Standing order, Standardization, Utilization.

Mapping wasted children using data from the Ethiopia Demographic and Health Surveys between 2000 and 2019: A bayesian geospatial analysis

ObjectivesUndernutrition, particularly wasting, is continuing to be a major challenge in developing countries like Ethiopia. However, data on the geographic variations over time are limited. We aimed to investigate the spatiotemporal variation of wasting in Ethiopia using two decades of Ethiopia Demographic and Health Surveys data, from 2000 to 2019. MethodsTrend and geospatial regression analysis using a bayesian framework were used to predict wasting in Ethiopia among children aged <5 y. The primary outcomes (wasting) were obtained from the Ethiopia Demographic and Health Surveys conducted between 2000 and 2019. Covariates were accessed from different publicly available credible sources at a high resolution. The spatial binomial regression model through the bayesian framework was fitted to identify drivers of wasting among children in Ethiopia. ResultsThe overall national prevalence of wasting among children aged <5 y in Ethiopia was 11.9% in 2000, 11.1% in 2005, 10.2% in 2011, 12.3% in 2016, and 9.4% in 2019, with substantial spatial variation across subnational and local levels over time. Spatial clustering of wasting was observed in eastern Ethiopia (Afar and Somali regions). Altitude (mean regression coefficient = –0.38; 95% credible interval, –0.69 to –0.07) and population density (mean regression coefficient = –0.02; 95% credible interval, –0.03 to –0.01) were negatively associated with wasting, whereas distance to health facilities (mean regression coefficient = 0.13; 95% credible interval, 0.03–0.23) was positively associated with wasting. ConclusionsThe reduction in the national prevalence of wasting among children was not as expected. Spatial clustering of wasting was observed in the northern, northeastern, eastern, and western parts of Ethiopia. Spatial clustering of wasting was associated with altitude, precipitation, population density, distance to health facilities, travel time to the nearest cities, and distance to a water body. Early screening and treatment of wasted children should be strengthened. Furthermore, outreach community awareness, especially in rural parts of the country, should be recommended through community health extension workers.

Determining staffing needs for improving primary health care service delivery in Kaduna State, Nigeria.

Background: The equitable distribution of a skilled health workforce is critical to health service delivery. Kaduna state has taken significant steps to revamp the primary health care system to ensure access to health care for its populace. However, these investments are yet to yield the desired outcomes due to health workforce shortages and the inequitable distribution of those available. Methods: A Workload Indicator for Staffing Need (WISN) study was conducted at Kaduna state's primary health care level. The study focused on estimating staffing requirements; Nurses/Midwives and Community Health Worker practitioners, Community Health Officers, Community Health Extension Workers, and Junior Community Health Extension Workers in all government-prioritised primary health care facilities. A total of ten focal primary health care facilities in Kaduna North Local Government Area (LGA) were included in the study. Results: Findings from the study revealed a shortage of Nurses/Midwives and Community Health Workers across the study facilities. For the Nurse/Midwife staffing category, nine of the ten PHCs have a WISN ratio < 1, indicating that the number of staff in the Nurse/Midwife category is insufficient to cope with the workload. In two of the ten primary health care facilities, there is an excess in the number of CHWs available; a WISN ratio > 1 was calculated. Conclusion: The WISN study highlights staffing needs in Kaduna State's government-prioritised primary health care facilities. This evidence establishes the basis for applying an evidence-based approach to determining staffing needs across the primary health care sector in the State to guide workforce planning strategies and future investments in the health sector. The World Health Organisation (WHO) WISN tool is useful for estimating staffing needs required to cope with workload pressures, particularly in a resource-constrained environment like Kaduna State.

Community health extension workers' training and supervision in Ethiopia: Exploring impact and implementation challenges for non-communicable disease service delivery.

Training and supervision of health workers are critical components of any health system;thus, we assessed how they impact health extension workers' (HEWs) role in non-communicable disease (NCD) service delivery in Ethiopia's health extension program (HEP), using an in-depth qualitative study conducted in 2019.The study covered two regions-the Tigray and the South Nations, Nationalities and Peoples Region (SNNPR)-and involved the Federal Ministry of Health. We conducted twenty-seven key informant interviews with federal and regional policymakers, district health officials, health centre representatives and HEWs.Participants highlighted substantial implementation challenges with training and supervision practices delivered via the HEP. Training for NCDs lacked breadth and depth. IT was described as inconsistently delivered with variable availability within and between regions;and when available, the quality was low with scant content specific to NCDs. HEP supervision was inconsistent and, rather than being supportive, mainly focused on finding faults in HEW work practices. Supervisors themselves had skill gaps in critical areas overall, and specifically concerning NCDs. HEWs' performance appraisal encompassed too many indicators, leading to excessive complexity, which was burdensome to HEWs. This, negatively impacted HEW motivation and compromised service delivery. HEW involvement in non-HEP activities (such as promoting other government programs) often competed with their core mandates, thus affecting HEP service delivery.Efforts to address training and supervision constraints in Ethiopia's HEP should focus on improving the quality of NCD training for HEWs and supervisors, shifting from authoritative to supportive supervision, simplifying performance appraisal and reducing competing attention from other programs.

PREVALENCE OF WORKPLACE VIOLENCE AGAINST PRIMARY HEALTHCARE WORKERS IN PORT HARCOURT

Background: Workplace Violence (WPV) is commonest in the health sector globally and this constitutes a great hazard especially for primary healthcare workers (PHCW). Yet not much studies have been carried out in this area for PHCWs in the Niger Delta region especially in Port Harcourt City and Rivers State Nigeria. Method: Descriptive cross-sectional study. The study population was 230 PHCWs (doctors, nurses, Community health extension workers). The sample size of 95 workers was determined using Cochran’s formula. Respondents were randomly selected through a multi-staged sampling method. A standardized questionnaire adapted from “Workplace Violence in the health sector” (WHO, ILO, PSI) was self-administered to the 105 respondents (10 extra respondents for non-response). Result: The result showed a response rate of 90.5%; Cronbach’s Alpha co-efficient of 0.84 (good internal consistency). Respondents were aged of 19 - 60 years old. Mean age was 42 years. Majority of the respondents (80%) were females. Most (75.6%) of them were married. The prevalence of WPV was 28.4%. There was no statistical significance between the age (p = 0.086), and sex (p = 0.361) and prevalence, but there was between professional cadre (p = 0.041) and most of the nurses experienced WPV during the period under study. Conclusion: In conclusion, healthcare workers in Port Harcourt City are experiencing WPV. This finding should be of great concern for authorities, healthcare worker and the public. It is recommended that the Rivers State Ministry of Health should educate/risk communicate to workers, patients/relative and sensitize the public in order to mitigate its occurrence. KEYWORDS: Violence, workplace, healthcare worke

Individual and ecological analyses of antenatal care: Prospects for delivery assistance and use of modern family planning in Nigeria.

Despite the availability of healthcare centres for the provision of antenatal care (ANC) services in Nigeria, the services are still underutilized by pregnant women. ANC services not only reduce maternal mortality and birth defects, but also have a strong link to many causes of maternal deaths. This study explored the individual and ecological relationships between antenatal care, skilled birth assistance during delivery, and family planning use across states in Nigeria. This study was a secondary analysis of data from the 2018 National Nutrition and Health Survey (NNHS) carried out among 24,985 women aged 15-49 years in the 36 states and the Federal Capital Territory (FCT) in Nigeria. Analysis was carried out at the level of individual women and at the ecological level. Only 68.3% visited a health professional (doctors, nurses, midwives, community health extension workers, and community health officers) for ANC in the most recent pregnancy before the survey. At delivery, 44.9% were assisted by delivery attendants with about half (50.1%) assisted by non-professional (traditional birth attendants, relatives and friends) during delivery. There was a significant variation in use of modern family planning (FP) across types of ANC provider. There was a strong positive correlation between ANC utilisation and skilled birth attendance (SBA) (r=0.706, p <0.001), and between SBA and FP (r=0.730, p <0.001). These results have implications for the design of appropriate interventions for strengthening the role of healthcare providers to enhance ANC patronage, utilization of safe delivery services and sustained use of reproductive health services.

Perception of providers on use of the WHO mental health Gap Action Programme-Intervention Guide (mhGAP-IG) electronic version and smartphone-based clinical guidance in Nigerian primary care settings

BackgroundTaking advantage of the rapidly increasing access to digital technology in low- and middle-income countries, the World Health Organization has launched an electronic version of the mental health Gap Action Programme intervention guide (emhGAP-IG). This is suitable for use on smartphones or tablets by non-specialist primary healthcare providers (PHCWs) to deliver evidence-based intervention for priority mental, neurological and substance use disorders. We assessed the perceptions of PHCWs on the feasibility, acceptability, and benefits of using smartphone-based clinical guidance and the emhGAP-IG in the management of people with mental health conditions in Nigeria. MethodsExploration of the views of PHCWs from 12 rural and urban primary health clinics (PHCs) in South-Western Nigeria were carried out using 34 in-depth key informant qualitative interviews with nurses (n = 10), community health officers (n = 13) and community health extension workers (n = 11). An additional two focus group discussions, each comprising eight participants drawn from across the range of characteristics of PHCWs, were also conducted. Thematic analysis was conducted using a three-staged constant comparison technique to refine and categorise the data.ResultsThree overall themes were identified around the use of clinical guidance and mobile applications (apps) in PHCs. Apps were deployed for purposes other than clinical consultation and decision making. Although paper-based guidance was the expected practice, its utilization is not fully embedded in routine care. An app-based decision-making tool was preferred to paper by PHCWs. Future usage of the emhGAP-IG would be facilitated by training and supporting of staff, helpful design features, and obtaining patients’ buy-in.ConclusionOur findings suggest that the emhGAP-IG could be a viable way to embed clinical guidance and decision-making tools in the management of people with mental health conditions in Nigerian PHCs.

Https://www.texilajournal.com/public-health/article/2153-covid-19-lockdown-health

Standing order is the instrument with which the community health extension workers (CHEW) were trained and are expected to use when attending to patients at primary health care facilities. The purpose of this study is to investigate the perceptions of the CHEWs on the standing order. The research was prospective and cross-sectional in nature and used a self-applied structured questionnaire distributed to eligible CHEWs between the months of March and April 2022. The age of the respondents ranged between 23 and 58 years, with a mean age of 42.5 years and a standard deviation of 6.03. 81.1% responded that standing order should be used by CHEWs at all times, while 86.8% responded that all CHEWs should use it when attending to patients. The perceptions of CHEWs on acceptability and credibility of standing order were high, but that of its usefulness was low. Keywords: Acceptability, Credibility, Usefulness.

Pharmacovigilance reporting during seasonal malaria chemoprevention campaign: Findings from northern Nigeria

BackgroundSeasonal malaria chemoprevention (SMC) campaign is known to reduce malaria-related morbidity and mortality among children aged 3 -59 months in the Sahel regions of Africa. However, the success of the intervention may be adversely affected by the absence of a robust pharmacovigilance system to monitor safety. This paper aims to describe our pharmacovigilance reporting experience during the campaigns conducted across seven states in Nigeria in 2020. MethodsThe SMC campaigns were held over four cycles from July to November 2020, with nearly 12 million eligible children reached by trained community drug distributors. Suspected adverse drug reactions were reported routinely through the national pharmacovigilance (PV) system. Completed PV forms submitted to the National Agency for Food, Drugs Administration and Control were retrieved and analyzed. ResultsThe adverse drug reaction (ADR) reporting across the seven states was low, with no ADR reports from five states. The ADRs reported included abdominal pain, weakness, diarrhea, fever, rash, and vomiting. Vomiting was the most reported ADR, accounting for almost half (28/57) of all reported cases. Children aged 12–59 months accounted for most (∼86%, 49/57) of the ADR reports, with over 70% (40/57) of these reports completed by community health extension workers. The system organ classification of ADRs showed that the gastrointestinal system was mainly affected (65%, 37/57). ConclusionOur experience suggests gaps with the pharmacovigilance surveillance system, highlighting the need to consider an active surveillance system, address behavioural factors, and explore the use of a digital reporting system.

Challenges to paediatric tuberculosis care as perceived by health workers in Kano, North-western Nigeria

Tuberculosis (TB) remains the world’s deadliest infectious disease that affects a third of the world’s population and newly infected an estimated 10 million people in 2018. The number of TB infected Nigerians ranks sixth in the world and first in Africa. Kano State has the highest Nigerian TB prevalence. I aimed to identify Paediatric TB care challenges as perceived by Kano Medical and DOT health care providers. The study design was prospective, descriptive and cross sectional involving structured questionnaire interviews of 43 healthcare providers, during TB supervision visits of 10 Health facilities in Kano. Generated data was entered, validated and analysed using the STATA 13 statistical software package. The sample size was convenient, since it is the number of all the health providers working in the facilities assigned to the author for supervision under a supervision contract with KNCV in 2017. Of the 43 respondents, there were 26 males, with a M: F ratio of 1.5: 1. Those health workers aged from 30 and 40 years constituted 58% of respondents. The staff cadre of respondents comprised of Community Health Extension Workers [CHEW] (40%), doctors (30%) and nurses (3%). Up to 51% of respondents had over 10 years health worker experience and greater than 36 months Child TB DOT care provision. The most commonly identified challenges to paediatric TB care included poor health knowledge (97.7%), poor health seeking behaviour (95.4%), poverty (95.4%), the inability of children to cough up sputum 95.4%, late presentation (90.7%), contact tracing logistics (90.7 %), patient and community factors of stigma and discrimination (86%) and poor health worker paediatric TB knowledge (70%). Perceived health worker challenges to effective Paediatric TB care were the adult orientation of the TB programme and its contact tracing logistic challenges, inadequate health worker Paediatric TB knowledge, children’s inability to cough up sputum, poverty, poor patient TB health knowledge, community stigma and discrimination, poor health seeking behaviour and late presentation.

Towards elimination of Lymphatic Filariasis in Kenya: improving advocacy, communication and social mobilization activities for mass drug administration, a qualitative study

IntroductionThe Kenya Breaking Transmission Strategy for Neglected Tropical Diseases (NTD) from 2019 to 2023 intensifies advocacy, coordination, and partnerships. The purpose of this study was to explore views and experiences of stakeholders and health workers on ways of improving the Advocacy, Communication and Social Mobilization (ACSM) activities of Mass Drug Administration (MDA) for Lymphatic Filariasis (LF) programs through participatory approaches in Kilifi County, Kenya.MethodsTwo wards were purposely selected in the Kaloleni sub-county, Kilifi County, where there was an average treatment coverage of 56% in 2015, 50.5% in 2016. Qualitative data collection methods were employed, which included participatory meetings with county stakeholders to understand their views, experiences, and suggestions on how ACSM strategies can be improved in MDA for LF. Twelve In-Depth Interviews (IDIs) were conducted (six with opinion leaders and six with Community Health Extension Workers (CHEWs) and two semi-structured interviews (SSIs) were held with county and sub-county coordinators involved in MDA administration. The aim was to better to understand their perceptions of the NTD program about ACSM, challenges to ACSM strategies, and ways to improve the strategies for ACSM in MDA for LF. The Data was organized and classified into codes and themes using QSR NVIVO version 12.ResultsThe study observed the low participation of stakeholders in the ACSM activities of MDA for LF and identified potential areas for stakeholders’ involvement to strengthen the activities. Challenges hindering effective implementation of ACSM activities include late delivery of Information, Educational and Communication (IEC) and few IEC materials, insufficient funding, inadequate time allocated to reach the assigned households with messages, messaging, and packaging of information for dissemination due to the vastness of the area. The stakeholders recommended innovative strategies and techniques to improve ACSM activities.Discussion and conclusionThe results of this study show key challenges to ACSM implementation of MDA for LF. Implementers need to pay attention to these challenges to enhance the effectiveness of MDA per the Kenya NTD Breaking Transmission Strategy. ACSM efforts in MDA for LF control and elimination should be linked with overarching efforts to mainstream partnerships and coordination in control and elimination.

Fathers’ Complementary Feeding Support Moderates the Association Between Mothers’ Autonomous Household Decision-Making and Optimal Complementary Feeding

ObjectivesThe evidence base on the role of maternal decision-making autonomy in optimal complementary feeding practices is not consistent, leaving questions about moderation by social support. The objective of this research is to examine the moderation effect of fathers’ complementary feeding support on the association of maternal decision-making autonomy with complementary feeding indicators. MethodsWe used logistic regression interaction models to examine whether complementary feeding support was a moderator of the association between decision-making autonomy and complementary feeding using data from endline (cross-sectional) surveys administered to 495 cohabiting mothers and fathers of children aged 6–23 months in Igabi local government area (LGA), Kaduna State, Nigeria. The 12-month Alive & Thrive intervention engaged fathers through complementary feeding messages from religious and community leaders, text, and voice messages. Mothers received home visits and feeding bowls from community health extension workers (CHEWs). The intervention also included mass media messaging on radio and TV. ResultsMaternal decision-making autonomy was associated with minimum dietary diversity (AOR, 1.15; 95% CI, 1.00, 1.32), minimum meal frequency (AOR, 1.31; 95% CI, 1.11, 1.53), minimum acceptable diet (AOR, 1.24; 95% CI, 1.09, 1.41) and feeding children fish (AOR, 1.23; 95% CI, 1.08, 1.40). Complementary feeding support was associated with minimum dietary diversity (AOR, 1.38; 95% CI, 1.08, 1.75), minimum meal frequency (AOR, 1.34; 95% CI, 1.05, 1.70), minimum acceptable diet (AOR, 1.40; 95% CI, 1.14, 1.73), feeding eggs (AOR, 1.49; 95% CI, 1.16, 1.90) and feeding fish (AOR, 1.30; 95% CI, 1.06, 1.60). In the interaction models, the simple slopes for decision-making were significant for most of the complementary feeding indicators when fathers offered > 2 types of support. ConclusionsWithin the context of Kaduna, high levels of fathers’ complementary feeding support strengthen the association of maternal decision-making autonomy with complementary feeding practices. Funding SourcesThis research was funded by The Alive & Thrive initiative, managed by FHI Solutions, and funded by the Bill & Melinda Gates Foundation, Irish Aid, and other donors.

Designing a Scalable Nutrition Education Package to Improve Diets of Adolescent Girls Through Primary Schools in Ethiopia

ObjectivesImproving adolescent girls’ nutrition is a high priority for the government of Ethiopia due to its immediate benefits for girls’ education and foundational role in protecting the productive and reproductive lives of women. Alive and Thrive (A&T) aimed to develop and implement an effective nutrition education package for scaling up by government education and health authorities. MethodsWe applied the socio-ecological model of social behavior change to systematically develop and test contextualized nutrition interventions in Southern Nations, Nationalities, and Peoples’ (agrarian) and Somali (pastoralist) regions. Using multiple sources of data and information we identified gaps in dietary practices, barriers, motivations; influential persons; and channels of communication for reaching adolescent girls in primary schools and influential persons, at high coverage and with frequent contacts. Region specific interventions, protocols, tools, and materials were field tested and tailored to fit the contact points and capacity of schools. ResultsThree dietary practices were selected based on evidence of gaps and potential benefits, 1) dietary diversity through promotion of locally available foods and food groups missing from adolescent girls’ diets by region, 2) frequency of meals and 3) reducing the consumption of unhealthy foods. Teachers, parents and peers were found to have the greatest influence on adolescent girls’ dietary practices. Community leaders (including religious leaders in Somali) and health extension workers were influential among parents, and school principals and supervisors were important for motivating teachers. ConclusionsSystematically targeting priority behaviors, engaging key influential persons, achieving high coverage and frequency through existing multiple contact points, and utilizing communication channels available through in-classroom and other activities were critical for developing a feasible and scalable package of school-based nutrition education interventions. Using data to design interventions and streamline implementation strategies facilitated the scale up of an effective intervention package for schools. Funding SourcesBill & Melinda Gates Foundation, through A&T, managed by FHI Solutions.

Complementary Feeding Social and Behavior Change Communication for Fathers and Mothers Improves Children’s Consumption of Fish and Eggs and Minimum Meal Frequency in Kaduna State, Nigeria

ABSTRACTBackgroundFathers are key influencers of complementary feeding practices, but few studies in low- and middle-income countries have measured the effects of complementary feeding social and behavior change communication (SBCC) targeted at both fathers and mothers.ObjectivesThe aims of this study were to measure the effects of an SBCC intervention on children's dietary diversity (primary outcome) and other complementary feeding indicators, fathers’ and mothers’ complementary feeding knowledge, and fathers’ support for complementary feeding (secondary outcomes).MethodsThe 12-mo intervention in Kaduna State, Nigeria, engaged parents through community meetings, religious services, home visits from community health extension workers (CHEWs), mobile phone messages (fathers only), and mass media. Cross-sectional population-based surveys of cohabiting fathers and mothers with a child aged 6–23 mo were conducted, and regression models were used to compare results at baseline (n = 497) and endline (n = 495).ResultsChildren's minimum dietary diversity did not change from baseline to endline (62% to 65%, P = 0.441). Children's consumption of fish (36% to 44%, P = 0.012) and eggs (8% to 20%, P = 0.004) and minimum meal frequency (58% to 73%, P < 0.001) increased. Fathers’ and mothers’ knowledge of the timing of introduction of different foods and meal frequency improved. Fathers’ support for child feeding by providing money for food increased (79% to 90%, P < 0.001). Fathers’ and mothers’ reported intervention exposure was low (11–26% across types of SBCC). Child feeding outcomes were not associated with fathers’ exposure. Children's odds of both fish and egg consumption increased significantly with mothers’ exposure to community meetings, religious services, home visits, and television spots, and children's odds of minimum meal frequency increased significantly with mothers’ exposure to home visits.ConclusionsA multipronged SBCC intervention improved complementary feeding practices, fathers’ and mothers’ knowledge of complementary feeding, and fathers’ support for complementary feeding, despite low levels of reported exposure, which may have been influenced by coronavirus disease 2019 (COVID-19) disruptions. This trial was registered at ClinicalTrials.gov as NCT04835662.

Evaluating the Effectiveness of a Hybrid Model for Mobilization of Women for Cervical Cancer Screening; A Preliminary Report of a Pilot Project in Lagos, Nigeria. A Case Study of the Blue-Pink Center for Women's Health, Nigeria

PURPOSE Cervical cancer is the second commonest cancer in Nigeria, accounting for 14.8% of all cancer-related deaths in Nigeria. Studies have demonstrated poor knowledge and attitude of women toward cervical cancer, with screening rates as low as 0.7% among Nigerian women. Besides poor awareness and poverty, lack of easy access to cancer education and screening is among the biggest barriers to its effective prevention and control. Our project aimed to increase access to cervical cancer education and screening among rural and suburban women in Lagos, Nigeria. METHODS We introduced an integrated approach to mobilize women for cervical cancer screening (using Visual Inspection with Acetic Acid [VIA]) in four local councils in Lagos. This model involved a hybrid of a facility- and community-based provision of screening services. Daily, skilled nurses and community health extension workers actively mobilize community women for screening through a purpose-built screening center and regular community outreaches to mirror organized and opportunistic screening. Extensive community stakeholders engagement was used to mobilize women groups. Women were charged up to $2.92 to identify if putting a price deters willingness to screen and to evaluate the model's sustainability. Project evaluation was conducted by a mixed method of quantitative and qualitative assessments. RESULTS Within nine months of the pilot, 13,892 women received cancer education, 1,250 women had VIA, and 181 had cryotherapy. Knowledge about cervical cancer rose from an average of 13.7% in our pre-participation survey to 80% in the post-participation surveys. Increased trust in the screening was the commonest theme in the qualitative survey which increased service uptake. CONCLUSION Our preliminary findings show that this hybrid model increased access to, and uptake of, cervical cancer screening, even when a cost was attached. Provision of screening services in an organized and strategic people-oriented manner may yield better and sustained outcomes in resource-poor settings than either opportunistic screening or screening offered only as part of routine hospital services.

Infection prevention and control: knowledge, determinants and compliance among primary healthcare workers in enugu metropolis, south-east nigeria

SummaryIntroductionHealthcare workers have lost their lives in significant numbers in the discharge of their duties as a result of a breach in Infection Prevention and Control (IPC) procedures. The increasing incidence of emerging and re-emerging diseases complicates this burden. Adequate IPC includes administrative, environmental and personal protective control measures. This study assessed the knowledge, determinants and compliance to IPC among primary healthcare workers in Enugu Metropolis.MethodologyA cross-sectional study was done using a semi-structured interviewer-administered questionnaire. A multi-stage sampling technique was used to select 300 eligible Health Care Workers in Primary Health Care facilities. Analyses were done using IBM-SPSS version 23. Ethical approval was obtained from the Health Research Ethics Committee of UNTH Enugu.ResultsThe majority of the respondents were Community Health Extension Workers (CHEWs) or Community Health Officers (CHOs) and nurses 122 (40.7%), 197(65.7%) were female; with a mean age of 39.86 ± 9.62 years. Only 254(84.7%) of the respondents had previous IPC training and 82(27.3%) of them had good knowledge of IPC. Needle-stick injury was identified as a source of occupational exposure to infections amongst 185(61.7%). A majority, 244(81.3%) could not correctly identify all the moments of hand washing.ConclusionThe demonstrated poor level of knowledge and compliance to IPC demands more research to unravel this existing gap. However, these conditions can be improved by training the workers on IPC.

Determining staffing needs for improving primary health care service delivery in Kaduna State, Nigeria.

Background: The equitable distribution of a skilled health workforce is critical to health service delivery, and Kaduna state has taken significant steps to revamp the primary health care system to ensure access to health care for its populace. However, some of these investments are yet to yield the desired outcomes due to workforce shortages and inequitable distribution of those available. Methods: A Workload Indicator for Staffing Need study was conducted at the primary health care level in Kaduna state. The study focused on estimating staffing requirements; Nurse/Midwife and Community Health Worker practitioners; Community Health Officer, Community Health Extension Worker and Junior Community Health Extension Worker, in all government prioritized primary health care facilities. Ten focal primary health care facilities in Kaduna North Local Government Area were included in the study. Results: Findings revealed a shortage of Nurses/Midwives and Community Health Workers across the study facilities. For the Nurse/Midwife staffing category, 9/10 PHCs have a Workload Indicator for Staffing Need ratio < 1; indicating that the number of staff in the Nurse/Midwife category is insufficient to cope with the workload. In two of the ten primary health care facilities, there is an excess in the number of CHWs available; a Workload Indicator for Staffing Need ratio > 1 was calculated. Conclusions: The Workload Indicator for Staffing Need study highlights the staffing needs in government prioritized primary health care facilities in Kaduna state. This evidence establishes the basis for the application of an evidence-based approach to determining staffing needs across the primary health care sector in the State, to guide workforce planning strategies and future investments in the health sector. The World Health Organisation Workload Indicator for Staffing Need tool is useful in estimating staffing needs required to cope with workload pressures, particularly in a resources-constrained environment like Kaduna State.

OPEN REDUCTION AND INTERNAL FIXATION BY A TRADITIONAL BONE SETTER AND QUACKS - A CASE REPORT AND REVIEW OF LITERATURE

Purpose: Open reduction and internal fixation of fractures is surgical procedure guided by standard principles and often performed by Orthopaedic specialists. Unfortunately, some quacks now dabble into performing these complex procedures resulting in several complications. However, it has becoming a serious public health concern in that a traditional bone setter in collaboration with some health workers (quacks who were community health extension workers) engaged in performing an open reduction and internal fixation for a femoral fracture in our index patient with very severe complications.&#x0D; Methodology: We present this case of open reduction and internal fixation by traditional bone setters and quacks to illustrate the extent of malpractices by traditional bone setters aided by quacks who have either been assisting Orthopaedic surgeons in the theatre or have been watching these procedures as they are frequently been carried out in the operating room.&#x0D; Results: This index patient, a university undergraduate presented via our outpatient clinic having been mismanaged by a traditional bone setter in collaboration with a Community health extension work. An informed consent was duly taken from the patient concerning the reporting of the case and he was fully clerked, investigated and managed until he left against medical advised due to financial constraints.&#x0D; Unique contribution to theory, practice and policy: We strongly recommend legislation and enforcement of laws that restrict traditional bone setters to limit their practices within their capacities under supervision if they must be allowed for any reason to practice management of simple fractures. The Community Health Extension Workers(CHEW) are to be under strict regulation by the Medical councils to prevent this unwholesome practices.

Contextual and psychological factors influencing open defecation free status: an exploratory qualitative study in rural South Western Uganda

IntroductionAchieving the Open defecation free (ODF) status remains a major challenge in Uganda, yet it contributes significantly to child health improvement. Literature on social, cultural and behavioral aspects that influence the ODF status in rural Uganda is limited. The study therefore, explored perceived factors influencing the ODF status in rural South Western Uganda.MethodsAn exploratory study employing qualitative techniques and based on deductive analysis between month December 2020 and January 2021 was conducted. Seven Focus Group Discussions (FGDs and three Key Informant Interviews (KIs) were conducted in Kabale District, southwestern Uganda. Focus Group Discussion participants were mothers and fathers having children of 2 years and below while KIIs included local community leaders and health extension workers. Data was analyzed using a categorization matrix derived from the Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) model which is comprised of contextual and psychological factors. Text was further categorized into high and low statements for attainment of ODF status.ResultsThe contextual factors influencing the Open Defecation Free status behavior included; farming activities far from home, financial constraints, rainy seasons, collapsible soft soils, and alcohol use. Psychological factors influencing ODF status included; perceived health risk for typhoid disease, low perceived severity for lack of ODF components, negative attitude of less value attached to ODF components, and a feeling of time wastage practicing ODF status behavior. The perception that the community has the ability to attain the ODF status was high. Although, the capability to maintain ODF was low when it comes to replacement of ODF component if stolen or destroyed.ConclusionOpen Defecation Free status is influenced by contextual and psychological factors. Therefore, it’s crucial for sanitation promotors to always identify such context specific factors in order to design sanitation and hygiene promotion interventions to address the ODF free status related challenges.