Health Facilities In Ibadan Research Articles

Prevalence of rectal carbapenem resistant Enterobacterales carriage among patients attending healthcare facilities in Ibadan, Nigeria: a descriptive study

BackgroundCarbapenem Resistant Enterobacterales (CRE) infections are increasingly associated with or directly responsible for morbidity and mortality from bacterial infections in sub-Saharan Africa where there are limited antibiotic options. CRE rectal colonization of patients in healthcare facilities provides a reservoir of these organisms and could potentially cause invasive infections in these settings. The prevalence of rectal carriage among patients attending healthcare facilities in Nigeria has not been previously described. We set out to assess the prevalence of rectal CRE carriage and their antibiotic susceptibility patterns among patients attending healthcare facilities in Nigeria.MethodsA descriptive cross-sectional study was carried out from December 2021 to September 2022 in Ibadan, in which patients attending primary, secondary and tertiary healthcare facilities were screened for rectal carriage of CRE by microscopy, culture and sensitivity of rectal swab specimens.ResultsA total of 291 patients were screened; 45 (15.5%), 66 (22.7%) and 180 (61.8%) at primary, secondary and tertiary healthcare facilities, respectively. All but one of them had received a third-generation cephalosporin or carbapenem in the preceding 30 days. The mean age was 28.8 years and 55.7% were male. Overall, 51 (17.5%) participants had CRE colonization, with 5(11.1%), 9(13.6%) and 37(20.6%) at primary, secondary and tertiary healthcare facilities, respectively (p = 0.243). Regarding antimicrobial susceptibility, 43(84.3%) CRE isolates were resistant to at least 3 different classes of antibiotics while two Escherichia coli isolates were resistant to all 5 classes of antibiotics tested. The lowest rates of CRE resistance were to tigecycline (6, 11.5%) and colistin (8, 15.7%).ConclusionsIn this first study on CRE colonization in Nigeria, we found that a substantial proportion of patients in three levels of healthcare facilities had rectal carriage of CRE, including pan-resistant isolates. Active surveillance and appropriate infection prevention and control practices (IPC) need to be urgently strengthened to mitigate the risk of active CRE infection.Trial registrationNot applicable.

Knowledge and Attitude of infant Feeding among Health Workers in Private Health Facilities in Ibadan, Oyo State, Nigeria

Knowledge and Attitude of infant Feeding among Health Workers in Private Health Facilities in Ibadan, Oyo State, Nigeria

Gestational weight gain among pregnant women in Ibadan, Nigeria: Pattern, predictors and pregnancy outcomes.

Gestational weight gain (GWG) is a risk factor for adverse pregnancy outcomes, future obesity and chronic diseases among women. However, has not received much attention in many low and middle-income countries such as Nigeria. We investigated the pattern, associated factors and pregnancy outcomes of GWG in Ibadan, Nigeria, using the Ibadan Pregnancy Cohort Study (IbPCS). The IbPCS is a multicentre prospective cohort study conducted among 1745 pregnant women recruited from four health facilities in Ibadan, Nigeria. GWG, the primary outcome, was categorised according to the Institute of Medicine's classification into insufficient, adequate and excessive weight gain. Pregnancy outcomes were the secondary outcome variables. Logistic regression analysis (Adjusted odds ratios and 95% confidence interval CI) was used to examine associations, and Poisson regression analyses were used to investigate associations with outcomes. Only 16.9% of women had optimal GWG, 56.8% had excessive GWG, and 26.9% had insufficient GWG. Excessive GWG was associated with high income '> #20,000-' (AOR: 1.64, 95% CI: 1.25-2.17), being overweight (AOR: 2.12, 95% CI: 1.52-2.95) and obese (AOR: 1.47, 95% CI: 1.02-2.13) after adjusting for confounders. In contrast, increased odds of insufficient GWG have associated women with depression (AOR: 1.70, 95% CI 1.17-2.47). There was no significant association between inappropriate GWG and pregnancy outcomes However, there was an increased odds for postpartum haemorrhage (AOR: 2.44, 95% CI 1.14-5.22) among women with obesity and excessive GWG. Excessive GWG was the most typical form of GWG among our study participants and was associated with high maternal income, and being overweight or obese. GWG needs to be monitored during antenatal care, and interventions that promote appropriate GWG should be implemented among pregnant women in Nigeria.

Psychiatric morbidity among pregnant and non pregnant women in Ibadan, Nigeria

A comparative cross-sectional study was conducted among 991 pregnant and 674 non-pregnant women of reproductive age attending healthcare facilities in Ibadan, Nigeria using the General Health Questionnaire-12 (GHQ), and WHO self-reporting questionnaire (SRQ). Logistic regression analysis was conducted to identify predictors of psychiatric morbidity at p < 0.05. A significantly higher proportion of pregnant women experienced psychological distress on the GHQ (51.8%) and psychiatric morbidity on SRQ (33.3%) compared with 28.6% and 18.2% of non-pregnant women, respectively. Predictors of psychiatric morbidity among pregnant women were the type of facility, poor satisfaction and communication with partners, the experience of violence in the home, previous abortions, and previous history of depression. Psychiatric morbidity among non-pregnant women was predicted by younger age, previous history of depression, poor satisfaction and communication with partners. There is a need for early identification of psychiatric morbidity among women of reproductive age, to ensure early interventions and prevent long-term disability. Impact statement What is already known on this subject? Psychiatric morbidity has immense effects on a woman’s quality of life, social functioning, obstetric outcome, and economic productivity. What do the results of this study add? Psychiatric morbidity among women of reproductive age is high. Pregnant women when compared to non-pregnant women had significantly higher rates of psychiatric morbidity. This high prevalence of psychiatric morbidity in both groups was predicted by poor satisfaction and communication with partners, and a previous history of depression. What are the implications of these findings for clinical practice and/or further research? Simple screening for women of reproductive age attending healthcare facilities may help with the early identification of psychiatric morbidity leading to prompt interventions, and preventing long-term disability.

Detections of mefA, ermB, and mphA Macrolides Resistant Genes in Bacteria Isolated from Covid-19 Patients from Selected Health Facilities in Ibadan, Nigeria

Background: COVID-19 is a disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Epidemiological data indicated that bacterial complications in COVID-19 would decrease clearance rate of the infecting agent and increase mortality rate. Macrolides such as Azithromycin are usually administered to COVID-19 patients as palliative treatments. Currently, a considerable number of bacterial strains have developed resistance to various antibiotics, especially macrolides. Resistance is reported to be due to possession of mefA, ermB, and mphA genes by Gram positive and Gram negative bacteria. Therefore, this study determined antibiotic resistance patterns and identify mefA, ermB and mphA macrolide-resistant genes in bacterial pathogens isolated from COVID-19 cases in Ibadan, Nigeria. Methods: 400 Nasopharyngeal samples were collected from symptomatic cases before antibiotic medication; structured questionnaires were administered to collect socio-demographic data of participants. Samples were cultured on Blood, Chocolate, MacConkey and Mannitol salt agar at 37°C for 48 hrs. Bacterial identification was performed using VITEK 2.0 ID cards and API 20E for Gram positive and negative bacteria respectively. Antibiotic Susceptibility Testing was performed using Kirby Bauer disc diffusion methods and VITEK 2.0 AST card kits. DNA of multidrug resistant bacterial isolates was extracted; resistant genes were determined using a polymerase chain reaction with specific primers. Amplified genes were detected using agarose gel electrophoresis. Results: 240 (60%) had bacterial growth and 97 (22.2%) yielded no growth. From the 240 bacterial isolates, 38 (15.83%) were multi-drug resistant including resistance to macrolides (Azithromycin) 20 (52.63%) of which were positive for either mefA or ermB, and none (0.0%) possess mphA gene; 14 (36.8%) isolates had mefA gene, 10 (26.3%) isolates carried ermB gene. Conclusion: Multi-drug bacterial resistance including macrolides and quinolones was detected. Only mefA and ermB genes were detected in the bacterial isolates, especially in Gram positive organisms. The detection of mefA and ermB genes in the MDR bacterial isolates raised concern on the use of azithromycin as palliative treatment for COVID-19 symptomatic patients.

Exploring women's preferences for attributes of long-acting reversible contraceptive (LARC) methods: A discrete choice experiment

There is low LARC uptake in Nigeria and not much is documented about Nigerian women's preferences for these products and how these preferences affect women's choices. Therefore, the purpose of this study is to provide empirical evidence on the decision-making behavior of Nigerian women regarding LARCs. Three hypothetical LARCs were presented. Informed by results obtained from the review of relevant literature and focus group discussion held with selected family planning services providers, the identified attributes were effect on weight, cost, LARC effectiveness and effect on bleeding patterns, each at three levels. A d-optimal design was used to construct nine choice sets. An additional choice set was included to conduct the test-retest stability test. The choice sets and other socio-demographic questions formed the discrete choice experiment questionnaire. A random sample of 150 eligible women was selected from women who enrolled and attended family planning clinics in public healthcare facilities in Ibadan, Nigeria through a three-stage sampling technique. Mixed logit modeling was used to obtain estimates of the parameters and willingness to pay (WTP) for each attribute was calculated. The test-retest stability result showed that 76.7% of the respondents responded in a consistent and rational manner. The women preferred LARCs that have no effect on their weights compared to LARCs that cause either slight weight loss or gain. Also, they preferred LARCs that offer 1/1000 level of effectiveness in a year. The most preferred attribute level, ‘women experience infrequent bleeding’, increases WTP by NGN 13,984.584 (USD 33.68) while the least preferred level, ‘women experience frequent/prolonged bleeding’, has a negative mean WTP (-NGN 19,598.378 (-USD 47.20)) indicating dispreference for the level. Furthermore, women derived higher utilities from very cheap LARCs. Evidence-based information on women's preferences regarding LARC usage would help policymakers in the deployment of strategies that would ensure that preferred LARCs are procured and made readily available to women.

Directly observed and reported respectful maternity care received during childbirth in public health facilities, Ibadan Metropolis, Nigeria.

Respectful maternity care (RMC) is believed to improve women’s childbirth experience and increase health facility delivery. Unfortunately, few women in low- and middle-income countries experience RMC. Patient surveys and independent observations have been used to evaluate RMC, though seldom together. In this study, we assessed RMC received by women using two methodologies and evaluated the associated factors of RMC received. This was a cross-sectional study conducted in nine public health facilities in Ibadan, a large metropolis in Nigeria. We selected 269 pregnant women by cluster sampling. External clinical observers observed them during childbirth using the 29-item Maternal and Child Health Integrated Program RMC observational checklist. The same women were interviewed postpartum using the 15-item RMC scale for self-reported RMC. We analysed total RMC scores and RMC sub-category scores for each tool. All scores were converted to a percentage of the maximum possible to facilitate comparison. Correlation and agreement between the observed and reported RMC scores were determined using Pearson’s correlation and Bland-Altman analysis respectively. Multiple linear regression was used to identify factors associated with observed RMC. No woman received 100% of the observed RMC items. Self-reported RMC scores were much higher than those observed. The two measures were weakly positively correlated (rho = 0.164, 95%CI: 0.045–0.278, p = 0.007), but had poor agreement. The lowest scoring sub-categories of observed RMC were information and consent (14.0%), then privacy (28.0%). Twenty-eight percent of women (95%CI: 23.0% -33.0%) were observed to be hit during labour and only 8.2% (95%CI: 4.0%-18.0%) received pain relief. Equitable care was the highest sub-category for both observed and reported RMC. Being employed and having completed post-secondary education were significantly associated with higher observed RMC scores. There were also significant facility differences in observed RMC. In conclusion, the women reported higher levels of RMC than were observed indicating that these two methodologies to evaluate RMC give very different results. More consensus and standardisation are required in determining the cut-offs to quantify the proportion of women receiving RMC. The low levels of RMC observed in the study require attention, and it is important to ensure that women are treated equitably, irrespective of personal characteristics or facility context.

Seroprevalence of leptospirosis among presumptive malaria patients in a secondary health facility in Oyo state, Southwest Nigeria

Background: Leptospirosis is a neglected tropical zoonoses that presents with fever and can be misdiagnosed, with fatal outcomes. Its incidence has been on the increase in recent times with 1 million cases and over 60,000 deaths reported annually worldwide. We determined the seroprevalence of leptospirosis and associated risk factors among presumptive malaria patients in a secondary health facility in Ibadan. Methods: We used Leptospira Rapid Diagnostic Test kit to estimate the seroprevalence of leptospirosis among 143 patients who presented at the study center between 27th April and 15th May 2019 whom a physician had seen and presumed they had malaria. We used one drop of blood for the test from blood collected by trained laboratory technicians for malaria diagnosis. Data on patients’ demographics and risk factors were collected using an interviewer-administered questionnaire. We calculated frequencies, means and proportion and also calculated odds ratios at 95% confidence interval (α=0.05). Result: The median age of the participants was 34 years (range: 6 months-80 years). Eighty-nine (62.2%) of them were females. Of the 143 tested, 12 (8.4%) were positive for <i>Leptospira</i> IgM/IgG antibodies. Eleven (7.7%) patients were positive for malaria. One (0.7%) was positive for both malaria and leptospirosis. Owning a backyard garden was significantly associated with leptospirosis (OR: 3.7, CI: 1.01-12.92).

A quantitative study of nurses perception to advance directive in selected private and public secondary healthcare facilities in Ibadan, Nigeria

ObjectivesThe study evaluated nurses’ perceptions on the benefits, drawbacks, and their roles in initiating and implementing advance directives (AD) at private and public secondary healthcare units.MethodsThe study adopted a cross-sectional, comparative-descriptive research design and was anchored on the structural functional theory. A total of 401 nurses (131 private and 270 public) were chosen on purpose. The data was collected between January and March 2018 among nurses at the selected hospitals. Analysis was done via SPSSv28.0.1.0.ResultsCompared to nurses working in private healthcare facilities (72.5%), the majority of nurses at the public healthcare facilities (75.2%) indicated a more favorable opinion of AD’s benefits and (61.9%) felt they had a substantial involvement in the development and execution of AD than their private counterpart (56.5%). Similarly, 60.7% of nurses employed by the government agreed that AD has some disadvantages compared to those employed by the private sector (58.8%). Significantly, Christian nurses are 0.53 times less likely than Muslims to contest AD’s benefits; 0.78 times less likely than Muslim to disagree that AD has flaws; and 1.30 times more likely than Muslim nurses to deny they contributed to the development and execution of AD, though not significant.ConclusionMaking decisions at the end-of-life can be challenging, thus AD should be supported across the board in the healthcare industry. Nurses should be trained on their role in developing and implementing AD, as well as on its advantages and how to deal with its challenges.

The Ibadan Pregnancy Cohort Study (IbPCS), a Prospective Cohort Study Protocol

Maternal obesity is a neglected public health challenge in Nigeria, even though it's associated with adverse metabolic, pregnancy, postpartum outcomes and future risk of non-communicable diseases. The Ibadan Pregnancy Cohort Study (IbPCS) investigates maternal obesity, lifestyle factors and the associated pregnancy and postpartum outcomes in Ibadan, Nigeria. IbPCS is an ongoing prospective cohort study that enrolled 1745 pregnant women at ≤ 20 weeks gestation at their first antenatal visit from four health facilities in Ibadan. Maternal body mass index (BMI) and lifestyle characteristics (Physical Activity - PA and Dietary Pattern) were assessed during enrollment using the pregnancy physical activity questionnaire and a qualitative food frequency questionnaire. The follow-up of participants was at 24 -28 weeks, third trimester, delivery and the postpartum period. Biomarkers (blood glucose and lipids) were assessed during the Oral Glucose Tolerance Test conducted between 24 – 28 weeks' gestation after an overnight fast. Baseline characteristics were: age (29.8±5.3 years), BMI (26.2±7.1kg/m2), primigravida (32.4%) , married (94.2%) , and tertiary level education (68.3%). This study will provide the preventive tools and lifestyle modification strategies required to mitigate the adverse effect of maternal obesity on maternal and child health and a future epidemic of cardio-metabolic diseases in Nigeria

The Role of Trust in the Pattern of Enrollment to a Social Health Insurance Scheme and Distribution of Healthcare Facilities in Ibadan, Southwest Nigeria.

The National Health Insurance Scheme (NHIS) of Nigeria established in the year 2005 aims to minimize the inequity of access to quality healthcare services in Nigeria. As of the year 2017, enrollment in NHIS-accredited facilities in the southwest region of Nigeria was significantly clustered, with more than three-quarters of NHIS enrollees registered with only 10% of the available NHIS-accredited facilities in the six states of the region. This study explored the factors associated with the skewed distribution of enrollees across facilities and the influence of stakeholders. This is a descriptive, qualitative, case study design among stakeholders of the NHIS in Ibadan, Oyo State, Southwest, Nigeria. In-depth interviews were conducted between March and June, 2019, with all selected individual stakeholders as listed earlier. Data analysis was done using an inductive thematic approach. Across the board, there was a low level of trust in government and government policies among healthcare providers and enrollees. Few healthcare providers were willing to render services under the scheme at inception. The majority of the enrollees were compelled to register with the few available healthcare providers. Among the enrollees, a few personally chose healthcare facilities and providers that were perceived to render better quality services to receive care. Priority should be given to building trust among stakeholders in the NHIS as this would facilitate cooperation and better working relationship, and reposition the scheme for better performance.

Perception and utilization of prevention of mother-to-child transmission of human immunodeficiency virus (HIV) services among women living with HIV.

INTRODUCTIONMother-to-child transmission is the major route of pediatric Human Immunodeficiency Virus (HIV) infection accounting for 90% of childhood HIV infection. Poor utilization of prevention of mother-to-child transmission (PMTCT) of HIV services has been shown in this situation. Hence, the study assessed the perception and utilization of PMTCT services among Women Living with HIV (WLHIV).METHODSA cross-sectional research design was used with a purposive sampling technique to select 182 WLHIV within reproductive age attending President’s Emergency Plan for Acquired Immunodeficiency Syndrome (AIDS) Relief (PEPFAR)/AIDS Prevention Initiative in Nigeria (APIN) clinic in two secondary Health facilities in Ibadan, Oyo State. A validated structured questionnaire was used for data collection. Descriptive and inferential statistics were used for data analysis.RESULTSThe mean age of the women was 37.0±6.5 years. Majority (74.2%) of the respondents had good knowledge on PMTCT of HIV, positive perception (89%) towards PMTCT services while only 42.9% of the respondents have utilized PMTCT services during pregnancy. However, some of the challenges to use of PMTCT services identified by the respondents were stigma (16.5%), discrimination (15.4%), financial constraint (11.5%) and non-involvement of partner (8.2%). There was a significant association between level of knowledge and PMTCT services utilization (χ2=6.244, p=0.012).CONCLUSIONSThere is need for improvement of knowledge and perception of HIV, MTCT and PMTCT among women through counseling and antenatal education, thereby increasing PMTCT services uptake. Partner involvement, good quality PMTCT services and lack of discrimination of people living with HIV in our society should be encouraged, hence promoting the utilization of PMTCT services.

Antibiotic Susceptibility Patterns and Extended Spectrum Beta-Lactamase (ESBL) production in Enterobactericeae Isolated from Stool Samples of HIV and AIDS Patients in Ibadan, Nigeria

Background and Objectives: Abuse and indiscriminate use of antibiotics, prolong hospital admission, travel history, organ transplants, immunocompromised conditions and age are parts of the factors that contribute to development of antibiotic resistance and intestinal carriage of Extended Spectrum Beta-Lactamases (ESBL) Enterobacteriaceae. These bacteria affect the course and outcome of an infection and continue to pose a challenge to infection management worldwide. This study was carried out to determine the antimicrobial susceptibility patterns and prevalence of ESBL-producing Enterobacteriaceae isolated from stool samples of HIV and AIDS patients in Ibadan, Nigeria.&#x0D; Materials and Methods: One hundred stool samples were collected from consenting HIV and AIDS patients accessing care in Antiretroviral (ARV) Clinic in a secondary and a tertiary health care facility in Ibadan, Nigeria. Gram-negative bacteria were isolated and identified using conventional methods. Antimicrobial susceptibility test was carried out using the Kirby Bauer disc diffusion technique. Phenotypic detection of ESBL-producing isolates was carried out using Double Disc Synergy Test (DDST).&#x0D; Results: A total of 240 Gram-negative bacteria were isolated comprising 100 (41.6%) Escherichia coli, 33(13.8%) Klebsiella pneumonia, 27(11.3%) Serratia marcescens, 20(8.3%) Salmonella enterica, 9(3.8%) Proteus vulgaris, 13(5.4%) Proteus mirabilis, 21(8.8%) Citrobacter freundii and 17(7.1%) Enterobacter aerogenes. Out these, 56 (23.3%) were ESBL-producers; comprising 23(41.0%) Escherichia coli, 9(16.0%) Klebsiella pneumonia, 6(10.7%) Serratia marcescens, 5(8.9%) Salmonella enterica, 3(5.3%) Proteus vulgaris, 5(8.9%) Proteus mirabilis, 2(3.6%) Citrobacter freundii and 3(5.4%) Enterobacter aerogenes. Among the ESBL producers, 45 (80.3%) and 38 (67.8%) showed resistance to trimethoprim/sulfamethoxazole and aztreonam while 3 (3.5%) showed resistance to ertapenem. Also, 96.4% (54/56) of the ESBL producers were multidrug resistant.&#x0D; Conclusion: This study showed that HIV and AIDS patients are reservoirs of ESBL-producing Enterobacteriaceae through faecal carriage, presenting them as likely source of dissemination of ESBL producer in community and hospital settings.

Cost associated with hospitalization of non-adherent type 2 diabetes patients in a tertiary healthcare facility in Ibadan, Nigeria

Purpose: To estimate the cost of hospitalization associated with medication non-adherence among type 2 diabetes mellitus (T2DM) patients in a tertiary healthcare facility in Nigeria.&#x0D; Methods: Three hundred and fifty-four (354) medical records of T2DM patients admitted into the medical wards from 2013 to 2015 were used for the study. Medical records with history of medication non-adherence (MNA) prior to hospitalization as indicated by physicians were included in the study. Direct medical costs associated with the management of the patients during hospitalization were measured using out-of-pocket payer perspective. Pearson product moment correlation coefficient was used to determine the relationship between the variables, with p &lt; 0.05 considered statistically significant.&#x0D; Results: Among the 354 admitted patients, 226 (63.8 %) had a record of MNA. The mean age was 57.5years ± 14.6. The majority of the patients (61.5 %) were either petty traders or artisans/selfemployed. Duration of hospitalization increased with increase in number of comorbid disease (Pearson product moment correlation r = 0.13 p = 0.05). Total cost incurred during hospitalization was US$146,669.3 (average, $ 650.1), of which more than one quarter was cost of medications. Cost of management and cost of laboratory investigations increased with increase in the number of co-morbid diseases (r = 0.24, p = 0.00; r = 0.2, p = 0.02, respectively). Cost of management also increased with increase in days of hospitalization (r = 0.2, p = 0.00).&#x0D; Conclusion: Cost of hospitalization related to non-adherence to medication is high among the studied population. There is need to work out strategies to enhance adherence among diabetes patients.

Proximate Predictors of Vaginal Delivery in Primigravid women at a Tertiary Health Facility in Ibadan, Nigeria

Background&#x0D; Successful vaginal delivery (VD) is the desire of every parturient. This is however not always so especially for primigravid women. Predictive factors can help the counselling process and allay the anxiety that this group of parturients experience.&#x0D; Objective&#x0D; To determine the prevalence and predictors of vaginal delivery among primigravid women at a tertiary health facility.&#x0D; Methods&#x0D; This was a 6-month cross-sectional study of 200 primigravid women that were planned for vaginal delivery. Information was obtained using structured proforma. Bivariate and multivariable analysis was used to identify the proximate predictors of VD.&#x0D; Results&#x0D; The prevalence of vaginal delivery was 50.0%. Labour onset was spontaneous in 78.0%; 10.0% had engaged fetal head prior to labour onset while labour was augmented in 18.0% of the parturients. Labour lasted ≤12 hours in majority (67.5%) with about half (49.5%) having successful vaginal delivery. Factors predicting successful vaginal delivery were spontaneous labour onset (OR=3.555, 95% CI=1.626-7.774), booked pregnancy (OR=3.008, 95%CI=1.361-6.647), and early fetal head engagement (OR=6.484, 95% CI=1.686-24.943).&#x0D; Conclusion&#x0D; The identified predictive factors of vaginal delivery in this study will aid counselling of primigravid women regarding the likelihood of successful vaginal delivery especially in the absence of other obstetric complications.&#x0D; Rwanda J Med Health Sci 2021;4(1):20-36

Caesarean delivery rate and indications at a secondary healthcare Facility in Ibadan, South Western Nigeria: a five-year review.

Caesarean delivery is an essential surgical skill within the primary care setting aimed at reducing maternal morbidity and mortality. To determine the rate and indications for caesarean deliveries with a view to improving on the service delivery in the study area. A retrospective review of all caesarean deliveries over a five-year period, January 1st, 2012 to December 31st, 2016. A total of 2321 deliveries were recorded during the study duration and 481 of them were through caesarean section (CS) giving a caesarean section rate of 20.4%. The rate was higher in the multigravida 255 (53.1%). The commonest indication for caesarean section was previous caesarean section 131 (27.2%). Emergency caesarean delivery accounted for 278 (57.8%). Only 16 (3.3%) stayed more than five days postoperatively while the rest, 465 (96.7%), stayed less than five days. There was a gradual yearly increase in rate from 12.1% in 2012 to 19.5% in 2016. The rate of CS in this study has shown a gradual yearly increase with emergency CS having a higher percentage. Early diagnosis and referral of high-risk pregnancies from peripheral hospitals could reduce emergency CS among the study population.

The bypassing of healthcare facilities among National Health Insurance Scheme enrollees in Ibadan, Nigeria.

BackgroundBypassing occurs when patients knowingly visit a health facility other than the one they live nearest to. In Ibadan, southwest Nigeria, the majority of enrollees in the National Health Insurance Scheme (NHIS) receive medical care in just 12% of the available NHIS-accredited facilities. Given that enrollees access healthcare services at highly subsidized rates under the scheme, this study aimed to determine the factors responsible for the observed distribution of enrollees across these health facilities.MethodsThe study was a descriptive cross-sectional survey conducted among NHIS enrollees receiving care at outpatient departments of five randomly selected accredited health facilities in Ibadan. A total of 311 NHIS enrollees were consecutively recruited and a semistructured, pretested, interviewer-administered questionnaire was used to elicit information from respondents. Descriptive and inferential statistics were used to present results at 5% level of significance. Distance traveled by patients from their residence to the facilities was measured using Google maps.ResultsThe mean age of respondents was 37.1±16.1 y. There were 167 (53.7%) males and 224 (72.3%) were married. The bypassing rate was 174 (55.3%). More than a third of enrollees, 127 (41.0%), reported that their hospital choice was made based on physician referral, 130 (41.8%) based on personal choice, 26 (8.4%) based upon the recommendation of the Health Management Organization (HMO), while 27 (8.7%) were influenced by friends/family/colleagues. Bypassing was positively associated with educational status (X2 = 13.147, p=0.004). Respondents who bypassed expended additional time and money traveling to the farther away hospitals, 35.1 (±34.66) min and 389.51 (±545.21) naira per visit, respectively.ConclusionThe level of bypassing among enrollees was fairly high. Enrollees should be properly guided regarding the need to access healthcare in facilities closer to them by their HMOs and physicians in the case of referrals. This will reduce bypassing and the cost of travel leading to better outcomes among enrollees.

Barriers to Effective HIV Testing Services and Strategies for Its Promotion at the Primary Health Care Facilities in Ibadan, Nigeria

Background: HIV testing services (HTS) act as a critical entry point to HIV care, treatment and prevention services, and offer the opportunity for specially-trained health care providers to encourage avoidance of high risk sexual behaviour among both HIV negative and HIV-positive individuals. However, there are some challenges that can hinder effective delivery of HIV Counseling and Testing services by health care providers. This study was therefore designed to investigate barriers to effective HIV testing services and strategies for its promotion at the primary health care facilities in Ibadan.&#x0D; Methods: This descriptive cross-sectional study was carried out among health care providers in primary health care facilities in five local government areas in Ibadan metropolis, Nigeria. A 4-stage sampling techniques was used to select 19 respondents and interviewed using key informant interview guide. Interviews were transcribed verbatim. Spot check of transcripts were conducted to ensure completeness of the transcription. The data were sorted, categorized, and analyzed using a qualitative data analysis computer software package (NVivo).&#x0D; Results: All the respondents interviewed reported that, there were pre and post-tests counseling including HIV testing services in their facilities. Some respondents added there were laboratory services and linkages to other care and support services for those tested positive to HIV. However, most of the respondents reported insufficient consumables, insufficient staff, no privacy, lack of infrastructures as barriers to effective HIV testing services. Many of the respondents recommended community sensitization, more provision for consumables, drugs and kits as strategies for promoting HIV testing services.&#x0D; Conclusion: This study revealed that the primary health centres have pre-test and post-test HIV counseling services but insufficient consumables and staff were the major barriers to HIV testing services in this study. It is therefore necessary for government to make provision for consumables and more personnel to boost the activities of the health facilities.

The effect of an educational intervention to improve tuberculosis infection control among nurses in Ibadan, south-west Nigeria: a quasi-experimental study

BackgroundNurses are particularly vulnerable to acquiring tuberculosis (TB) because they are in the frontline of patient care. There is inadequate implementation of cost-effective TB infection control (TBIC) measures in most health facilities. Training has been shown to be effective in improving the knowledge and work practices of nurses. This study sought to utilize a multi-method educational intervention to improve the TBIC-related knowledge and practices of nurses in two secondary health facilities in Ibadan, South-West Nigeria.MethodsThis quasi-experimental study involved 200 nurses (100 each in the intervention and comparison groups). Baseline data were collected in May 2014. This was followed by training of the nurses in the intervention group. After 6 months, the second wave of data was collected and the nurses in the comparison group also received the training thereafter. The final wave of data collection took place 12 months after the commencement of the study. The mean scores of the nurses were determined and comparison was made between both groups at different time points using independent t-test.ResultsThe nurses in both groups were statistically comparable in their socio-demographic characteristics, and baseline mean knowledge (68.6 and 67.7%) and practice scores (79.1 and 80.6%) respectively. After the intervention group received the intervention, there were appreciable improvements in the scores at 6 months (knowledge – 85.9%, practice – 98.5%), which were significantly different from those of the comparison group (knowledge – 69.5%, practice – 78.8%). A large effect size was demonstrated in the improvement in knowledge score in the intervention group at 6 months compared with the other group (Cohen’s d = 1.7). Similarly, there were improvements in the scores of the nurses in the comparison group at 12 months after the group had also received the intervention (knowledge – 88.2%, practice – 93.5%). At this point, the mean scores between both groups were no longer significantly different.ConclusionsThe improvement in post-intervention scores implies that the educational intervention adopted for this study was effective in improving TBIC among the nurses. It also underscores the importance of continuous training/retraining of nurses and other healthcare workers in improving and sustaining TBIC at health facilities.

Trends in contraceptive uptake at a tertiary health facility in Ibadan, Nigeria

Background: Low utilization of modern contraceptive is one of the key determinants of high fertility in Nigeria. Objective: The objective of this study was to determine the yearly prevalence and trend of contraceptive use among women of reproductive age-group who attended a family planning clinic in Ibadan, Nigeria. Materials and Methods: A clinical audit of contraceptive uptake was undertaken at the family planning clinic of University College Hospital, Ibadan, Nigeria, from January 1, 2011 through December 31, 2018. Information on the client’s age, type of contraceptive utilized, and total number of each contraceptive method used per year was obtained. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 20.0. Results: A total of 13,023 women utilized at least one form of contraceptive with mean age of 35.53 ± 9.1 years. Implant (31.2%) was the most widely utilized contraceptive, whereas bilateral tubal ligation (0.4%) was the least utilized. Other methods were intrauterine contraceptive device, injectable, condom (male and female), and oral contraceptive accounting for 26.9%, 19.3%, 16.7%, and 5.5%, respectively. A significant decrease was observed in the trend of use of modern hormonal contraceptive methods as compared to the nonhormonal methods over the 8 years studied (P < 0.001). Conclusion: Implant being the most utilized indicates that it is the most accepted and approved by clients in our clinic. The knowledge of contraceptive utilization trends can be used to monitor and appraise the acceptance and approval of each method and family planning programs over a period.