Outreach Centres Research Articles

IJCM_310A: Active Case Finding for Tuberculosis in outreach centres of a medical college in Puducherry, India: A Mixed Methods Study on Outcomes and Implementation Challenges

Background: Tuberculosis is the leading cause of death from a curable infectious disease and is responsible for 9.9 million new cases and 1.3 million deaths. Over 95% of TB deaths occur in low and middle-income countries. The WHO TB statistics for India for 2021 give an estimated incidence figure of 2,590,000 million cases. In Puducherry, 4500 cases were notified in the same year, with a TB notification rate of 226 per lakh population. ACF has potential benefits but also challenges, which need to be carefully assessed when developing and implementing ACF policies. Objectives: 1) To understand the experiences of healthcare workers during the implementation of Active Case Finding (ACF) activities 2) To assess the implementation of ACF using the feasibility indicators. Methodology: Qualitative interviews (IDI & FGD) were conducted among healthcare workers (Nodal Officers, Medical Officers, and Medical Interns) involved in the ACF to enumerate their experiences during the survey and the implementation challenges they faced. Additionally, a set of feasibility indicators from the literature (Hemant et al.2023) was identified to assess the implementation of ACF in outreach centres of a medical college in Puducherry. Results: Three overarching themes emerged through qualitative interviews: awareness of ACF and TB, implementation challenges, and mechanisms to overcome the challenges. Feasibility indicators will be elicited upon completion of data curation and analysis. Conclusion: The intricate details involved in the implementation of ACF would be understood through the experiences of Health Care Workers as well as quantitative estimation of ACF implementation.

Nutritional status and its associated factors among the geriatric population in outpatient clinics of a tertiary care hospital in Karachi, Pakistan.

Elderly malnourishment remains a largely unexplored area, despite having a significant effect on the level of mortality and morbidity. This study aims to explore the level of malnourishment and identify those at risk of malnourishment among the elderly population presenting to a teaching hospital in Karachi. To assess nutritional status and its associated factors among the elderly population. This study was conducted in outpatient clinics of family medicine at a teaching hospital and its outreach primary care centres from December 2020 to December 2021. The study design was cross-sectional. The prevalence of malnourishment and at risk of malnourishment with its associated factors were assessed using the Mini-Nutritional Assessment (MNA) scale as a screening tool among the elderly population (65 years and above) presenting to the family medicine OPDs of a teaching hospital. Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 21. A total of 191 patients were recruited into the study, and the majority of them were males (66.5%). Median age and body mass index (BMI) of participants were 70 (IQR = 74-65) years and 24 (IQR = 27-21) kg/m2, respectively. The median MNA scores were 23.5 (IQR = 20.5-26). A total of 92 (48.2%) participants were found to have a normal nutritional status, 81 (42.4%) were found to be at a risk of malnourishment, and 18 (9.4%) were malnourished. On the multivariable regression model, BMI and ability to manage finances were significantly associated with malnourishment. This study shows an alarmingly high rate of the elderly population at risk of developing malnourishment, and financial independence and increasing BMI were associated with a decreased risk of malnourishment.

Index of Caries Experience – A Composite System for Recording Dental Caries

Abstract Introduction: Measurement of dental caries is imperative for its prevention and control. The present study was conducted with the aim of developing a dental caries index that is reliable, reversible, and valid. A cross-sectional study was designed and conducted at the outreach dental clinics of a dental school in India. Methods and Material: A total of 219 patients visiting outreach centres participated in the study. Patients attending outreach dental clinics aged 15 years and above, who were dentate and affected by dental caries, were included. Clinical examination was done under clinical conditions with dental chair lighting. Decayed Missing and Filled Teeth (DMFT) and Index of Caries Experience (ICE) were recorded using the visuo-tactile method according to the index criteria. Results: The relationship between the DMFT and ICE was determined. Results showed that the DMFT from ICE had good correlation. The decayed teeth index (DTI) score varied from decayed teeth (DT) according to age and sex. DTI was significantly higher for females than for males and higher among younger age groups than older ones, but DT did not exhibit the differences. Conclusions: ICE is a new system in which the proviso is to measure the non-cavitated lesions and health of permanent dentition. DMFT and ICE have good correlation. DTI is more sensitive than the DT score.

Functional independence among a geriatric population in Karachi, Pakistan: A cross sectional study.

Objective: To find out the frequency and associated factors of impaired IADLs (instrumental activities of daily living) among the geriatric population of Pakistan. Study Design: Cross-sectional study. Setting: Department of Family Medicine and Outreach Centres, Liaquat National Hospital, Karachi. Period: Dec 2020 to Dec 2021. Material & Methods: A total of 200 participants of either gender aged above 60 years were included. At the time of data collection, demographic information was noted along with impairment in specific IADLs and associated factors. Results: Total 200 participants were included in the study. Median age and body mass index was 70 (IQR= 65-73) years and 24.8 (IQR= 21.8-27.8) Kg/m2. Majority of study participants considered that their health status is better (n=92, 46%) whereas some considered it as not as good (n=33, 16.5%) and good (n=55, 27.5%). Few had no idea about their health status (n=20, 10%). The enrolled participants had comorbidity of hypertension (n=78, 39%), diabetes (n=53, 26.5%), ischemic heart diseases (n=10, 5%) and hypothyroid (n=15, 7.5%). Overall 85 (42.5%) study participants were found to be dependent with median IADL score of 6 (IQR= 4-7). Conclusion: Quite a significant proportion of the study participants were found to be dependent. Advancing age, gender predisposition, perceived weight loss and psychological distress were found to be associated with impairment in instrumental activities of daily living.

Marine Stations Helgoland and Sylt operated by the Alfred Wegener Institute Helmholtz Centre for Polar and Marine Research

The Marine Stations Helgoland and Sylt are permanent coastal stations in the German Bight operated as one joint research infrastructure by the Alfred Wegener Institute Helmholtz Centre for Polar and Marine Research (AWI). Using both stations, the south-west region of the North Sea and its ecosystem features are tightly monitored via ecological time series, which are recorded and made available to government offices, professional associations, and research institutes world-wide. The stations are a hub for national and transnational access for guest researchers and visiting scientists in the German Bight. For over fifty years, the stations have served as centres of student education by providing facilities for university courses. The stations operate the coastal research vessels Mya II, Uthörn and Aade. The Biologische Anstalt Helgoland (BAH) is home to the AWI Centre for Scientific Diving, which conducts, promotes, and supports diver-related underwater science within the framework of all AWI research themes. The BAH is also home to the school laboratory OPENSEA, which offers high school students a scientific environment to explore marine science. The Wadden Sea Station on the island of Sylt offers 24 seawater mesocosms for ecological studies of future climate scenarios. Public outreach centres are associated with both locations (BLUEHOUSE and Erlebniszentrum Naturgewalten).

Factors affecting Nepalese rural dwellers’ choice of first-contact health facility: a cross-sectional survey

Background Despite significant progress in Nepal’s health indicators over the past three decades, regional disparities in public health centre (PHC) provision and accessibility remain severe. It has been reported that rural dwellers prefer and place more trust in outreach centres (ORCs) run by the Dhulikhel Hospital. However, the reasons behind this remain unclear. We aimed to examine the determinants of Nepalese rural dwellers’ choice of first-contact health facility. Methods This was a cross-sectional survey among 1,098 adult rural dwellers in Nepal. The study sample was first divided into PHC and ORC groups, and intergroup differences were tested using Pearson chi-square test and independent sample t-test. Then, binary logistic regression was performed to analyse first-contact health facility decision-making. Results Sex, education level, importance of health care satisfaction, importance of free health care, diagnosis of hypertension, diagnosis of diabetes, insurance coverage, savings, community-level cooperation, and distance to the health facility were significant factors affecting the choice of the first-contact health facility. Most significantly, people who were unconcerned about receiving free health care were 19.417 times more likely to use ORCs. Additionally, it was observed that rural dwellers perceived ORCs as providing higher quality health care. Conclusions The government must promote cooperation between PHCs and ORCs, as it is essential to understand consumer demand, supply-side issues, and institutional aspects of health care in rural areas to achieve universal access to health care.

Optimal Location and Allocation of Vaccination Outreach Centres

Optimal Location and Allocation of Vaccination Outreach Centres

Bacteriological Profile of Healthcare Workers and Patients’ Hands at Aga Khan University Hospital, Nairobi Outreach Centres

Background: Hand hygiene is the precursor to improved health standards among healthcare workers and patients seeking outpatient services. Unhygienic hands may escalate the transmission of multi-drug resistance bacteria that poses serious pathological manifestation to the vulnerable and susceptible patients. The study aims at establishing the possible pathogen and susceptibility pattern of Staphylococcus aureus carried on hands of healthcare provider and their patients.
 Methods: Cross sectional study design and random sampling of patients and convenient sampling of healthcare workers was carried out between May to August 2020 at Aga Khan University hospital Nairobi satellites. The participant’s hands palm and finger tips imprints were made on Blood agar during sample collection. The antimicrobial susceptibility pattern of Staphylococcus aureus was established using Vitek-2 automated system.
 Result: The study had 374 participants out of which 14% were colonized by possible pathogens. The overall Staphylococcus aureus hand carriage prevalence 6.9% (26/374) isolated from healthcare provider and patient at outpatient facility. The methicillin resistant staphylococcal in this study was 0.56% (2/374) showing resistance to both Oxacillin and Cefoxitin. Healthcare workers are prone to colonization with possible pathogens as compared to patient P-value .049. Staphylococcus aureus isolates were all resistant to penicillin.
 Conclusion: Hand hygiene mitigating measures in outpatient healthcare facilities should be sustained on the counts that 14% of possible pathogens in this study were isolated. Healthcare providers at the point of care in outpatient should strictly follow the hand hygiene protocols provided by WHO to curb the transmission of possible pathogenic bacteria.

Societal Need for Interdisciplinary Ageing Research: An International Alliance of Research Universities “Ageing, Longevity and Health” Stream (IARU-ALH) Position Statement

Ageing is a global concern with major social, health, and economic implications. While individual countries seek to develop responses to immediate, pressing needs, international attention and collaboration is required to most effectively address the multifaceted challenges and opportunities an ageing global population presents in the longer term. The Ageing, Longevity and Health stream of the International Alliance of Research Universities (IARU-ALH) was built on a solid foundation of first-class interdisciplinary research and on innovative outreach and communication centres. This interdisciplinary network conducts projects that span biology, medicine, social sciences, epidemiology, public health, policy, and demography, and actively engages with the public and other societal stakeholders. Here we posit that such international interdisciplinary networks are needed and uniquely placed to address major challenges related to health and ageing and ultimately will produce new understanding and knowledge to promote the awareness of healthy ageing and encourage societal change via novel, science-informed interventions. Global interdisciplinary research presents great potential and opportunities to accelerate our understanding of human ageing and to produce new, more effective solutions to a pressing, complex problem. However, more focused, strategic efforts and investments are required in order to deliver on these potentials and reap maximum benefits for individuals and societies. IARU-ALH members are determined to contribute, in collaboration with others, to delivering on this vision.

Acceptability of on-site rapid HIV/HBV/HCV testing and HBV vaccination among three at-risk populations in distinct community-healthcare outreach centres: the ANRS-SHS 154 CUBE study

BackgroundHIV, HBV and HCV infections continue to represent major health concerns, especially among key at-risk populations such as men who have sex with men (MSM), people who inject drugs (PWIDs), transgender women (TGW) and sex workers (SW). The objective of the ANRS-CUBE study was to evaluate the acceptability of a healthcare, community-based strategy offering a triple rapid HIV-HBV-HCV testing, and HBV vaccination, targeted at three priority groups (MSM, PWIDs and TGW/SWs), in three community centers, in the Paris area.MethodsThis longitudinal multicentric non-randomized study included all adult volunteers attending one of the three specialized community centers in Paris, between July 2014 and December 2015. HIV, HBV and HCV status and acceptability of HBV vaccination were evaluated.ResultsA total of 3662, MSM, 80 PWIDs and 72 TGW/SW were recruited in the three centers respectively. Acceptability of rapid tests was 98.5% in MSM and 14.9% in TGW/SWs, but could not be estimated in PWIDs since the number of users attending and the number of proposals were not recorded. User acceptability of HBV vaccination was weak, only 17.9% of the eligible MSM (neither vaccinated, nor infected) agreed to receive the first dose, 12.2% two doses, 5.9% had a complete vaccination. User acceptability of HBV vaccination was greater in PWIDs and TGW/SWs, but decreased for the last doses (66.7 and 53.3% respectively received a first dose, 24.4 and 26.7% a second dose and 6.7 and 0% a third dose). Fifty-three participants (49 MSM and 4 PWIDs) were discovered HIV positive, more than half with a recent infection. All but two HIV positive participants were linked to appropriate care in less than one month.ConclusionsRapid HIV-HCV-HBV screening showed a very high level of acceptability among MSM. Efforts need to be made to improve immediate acceptability for HBV vaccination, especially among MSM, and follow-up doses compliance. Our results show the important role of community centers in reaching targets, often fragile, populations, while also suggesting the need to reinforce on-site human support in terms of testing and vaccination, especially when addressing PWIDs.

Determinants of Adoption Rate of Rice Production Technologies Introduced by Agricultural Research Outreach Centres (AROCs) by Farmers in Niger State, Nigeria

The study assessed the determinants of adoption rate of rice production technologies introduced by Agricultural Research Outreach Centres in Nigeria. Data were collected using a multi-sampling technique. Data were analysed using simple descriptive statistics and multiple linear regression. Results revealed that respondents’ mean age was 50 years; level of formal education of farmers was low and farm size was 2.5ha on the average. Age, farming experience, years of schooling and number of extension visits were the socioeconomic determinants affecting rate of adoption. It was recommended that more villages should be selected with partnership between government and the private sector in order to cover more grounds and increase the rate of adoption of new technologies. Also, government and relevant stakeholders should prioritize establishment of the best extension teaching methods and systems as well as administration to help increase adoption rate of innovations and sustainability of the use of these technologies over time.

Patient experience within the adult congenital heart disease outreach network: a questionnaire-based study

BackgroundSpecialist multi-disciplinary care improves outcomes of Adult Congenital Heart Disease (ACHD) patients. Following the NHS England Congenital Heart Disease standards review, the aim is to deliver high quality, patient-centred, care closer to patients’ homes. Cardiac investigations performed on the same day of outpatient appointments reduce the non-attendance rates. This young cohort of patients, benefits from comprehensive multi-disciplinary management. We developed a Patient Questionnaire across our West Midlands ACHD network to measure patient experience.MethodsPatient questionnaires were distributed to patients attending outpatient clinics in all 8 Outreach Centres and the Level 1 ACHD Centre (University Hospitals Birmingham).Results71 males (55%) and 59 females (45%), median age range 25–34 years old (range between 16 and 75 years old), returned the questionnaires (n = 130).Most patients travelled less than one hour to hospital (93%, n = 120) and less than 20 miles (86%, n = 99). The mean travel distance was 14 ± 12.3 miles (range 1 to 160 miles), with Level 1 ACHD Centre patients travelling a significantly longer distance (mean 29.6 ± 44 miles) compared to the local Outreach Centres (mean 11.3 ± 9 miles, p = 0.0037).There was a wide variability in the provision of parking, although most patients found the appointment time and location convenient (91%, n = 117 and 95%, n = 121 respectively).There was also marked variation in the number of electrocardiograms (19–100%) and echocardiograms (0–60%) performed on the same day as their clinic appointment.Most patients felt they were given enough information regarding their condition (85%, n = 98), with no significant differences between the centres (p = 0.24).ConclusionTo our knowledge, this is the first questionnaire-based study assessing patient experience within the NHS ACHD Outreach network with significantly reduced travel times and maintained high patient satisfaction. There was a wide variation in investigations performed and patient information leaflets provided. Standardisation of services is required at all centres to ensure equity of care, with Specialist Nurses’ input and more availability of tests on the day of clinic appointments in all centres.

Health insurance a predominant medium for achieving universal healthcare in India ? A farfetched dream?

In India, there are two kinds of insurances - Social Health Insurance (e.g. Employees State Insurance Scheme) & Voluntary Health Insurance. Even after years of grappling with health insurances, 71% of the healthcare costs are borne by the households. CGHS (Central Government Health Scheme), ESI (Employees State Insurance) and private insurance providers are major participants but they often ignore the population that needs the healthcare insurance the most. Self Help Groups and NGOs extend a number of Community based health insurance schemes. However, this covers only less than 1% of the country?s population. ESIS and CGHS taken together constituted 41% of total spending on insurance. The government has rolled out various schemes like RSBY (Rashtriya Swasthya Bima Yojna) that cover population in informal sector but only the BPL (Below Poverty Line) and marginalized population. Still a large non-formal sector is there that is above the BPL but in dire need of health insurance as they are most susceptible to catastrophic health expenditures and fall below poverty line due to health expenditures. However, achieving universal coverage through compulsory health insurance has several roadblocks like a huge informal sector, uneven income levels, large rural population and variability in government policies. When it comes to healthcare service delivery, private providers account for majority of healthcare expenditure (76.74%). While in the public sector, the major providers are public hospitals, outreach centres, medical education, research and training institutes. A comprehensive health insurance scheme is needed instead of fragmented schemes to provide universal health coverage to the whole population. This short commentary tries to throw light on the inequity of healthcare insurance and service delivery in a complicated healthcare system of urban areas.

Evaluation of the Community Cataract Surgical Services of a University Teaching Hospital Using Cataract Surgical Coverage in Nigeria.

Cataract is the leading cause of blindness in the world. An efficient and effective cataract surgical service is necessary to reduce the backlog of cataract blindness in the community. This study aims to determine the cataract surgical coverage among individuals aged 50 years and above residing in Esie and Arandun communities. This will serve as a measure of the impact of the cataract intervention programme provided by the University of Ilorin Teaching Hospital, Nigeria. The study was a population-based, cross sectional survey conducted from November to December, 2013. Cataract surgical services are provided by the University of Ilorin Teaching Hospital, Nigeria, at Esie and Arandun communities as out-reach centres. Seven hundred and fifty-five individuals aged 50 years and above residing in these communities had basic ocular examination done. Out of the 765 subjects registered, 755(98.7%) were examined. Out of these, 38.4% were males and 61.6% were females. The prevalence of bilateral cataract blindness was 1.6%. The Cataract Surgical Coverage (eyes) at visual acuity < 3/60 for males and females were 52.3% and 51.2% respectively (X2=19.30, p=0.001), while the Cataract Surgical Coverage (person) at visual acuity less < 3/60 for males and females were 80.6% and 68.4% respectively (X2=2.10, p=0.147). The Cataract Surgical Coverage was high with a correspondingly low prevalence of cataract blindness in these communities. The availability of cataract surgical services via out-reach programmes bridges the gap between eye care-givers and the community.

Portuguese American gay men in southeastern Massachusetts: cultural scripts and risk for HIV

In this study, we examined the lived experiences of an understudied subgroup, Portuguese American gay men, within the context of sexual script theory. We employed a phenomenological study design with eight men to provide a more in-depth analysis of their sociocultural sexual behaviours. Recruitment was conducted through word of mouth and a snowball approach beginning with two well-known HIV education and prevention outreach centres in southeastern Massachusetts. In this study, the sexual scripts of the participants were conceptualised within the three domains of cultural, interpersonal and intrapsychic scripts. Our findings suggest the three scripts are constantly interacting and informing one another. This ongoing negotiation influences the way our participants position their sexuality within the broader context of their everyday life within the US Portuguese community. Participants script their sexuality while they navigate multiple but separate entities within their culture, their religion and their families. Learning from these experiences could have important implications for the development of HIV prevention programmes for specific subgroups of men who have sex with men.

A Comparative Study on Epidemiology, Spectrum and Outcome Analysis of Physical Trauma cases Presenting to Emergency Department of Dhulikhel Hospital, Kathmandu University Hospital and its Outreach Centers in Rural Area

Physical trauma is one of the major cause of mortality and morbidity among young and active age group and its increasing trend is of main concern. There are only few studies concerning the spectrum of physical trauma in Nepal. This study aims to evaluate the epidemiological spectrum, the extent, severity of the physical trauma and the outcome evaluation of patients with physical trauma over a period of one year in the emergency department of the Kathmandu University Hospital and compare the same parameters with those patients presenting to the various outreach centers of the hospital in the community. Patient treatment files from the emergency department and the reports from various outreach centers were retrieved for a period of one year (May 2011 to April 2012). Epidemiological information, mode, type and anatomic location of injuries were recorded. Outcome evaluation was assessed by number of patients discharged from emergency department of the hospital or the outreach centers after the treatment, patients admitted for inpatient management and referred to other centers for further specialty management. In a period of one year, total 2205 (20%) of physical trauma cases presented to the emergency department and 1994 (6.12%) in the outreach centres. Most commonly involved age group in physical trauma both in Hospital set up and in Community set up were the young adults (15 to 49 years). Fall from height was the commonest mode of injury followed by road traffic accidents among the patients coming to the hospital while significant number of trauma patients coming to outreach centers were due to fall from height. In the hospital set up, 1525 (69.2%) of the cases were discharged while 537 (24.4%) needed inpatient management and 85 (3.8%) needed referral to other centers for the specialty management. In case of outreaches, half of the patients were discharged after the primary treatment and almost another half were referred to the hospital, mainly for need of further investigations. Fall related injuries and road traffic accidents are the most common mode of trauma in the hospital set up and fall related injuries are the single most important mode of trauma seen in the outreaches. Mostly young adults in their active period of life are involved in physical trauma so appropriate preventive measures through public health approach should be included in comprehensive trauma management for reducing mortality and morbidity rates related to physical trauma.

Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners.

There is little literature on health-service-level strategies for culturally respectful care to Aboriginal and Torres Strait Islander Australians. We conducted two case studies, which involved one Aboriginal community controlled health care service and one state government-managed primary health care service, to examine cultural respect strategies, client experiences and barriers to cultural respect. Data were drawn from 22 interviews with staff from both services and four community assessment workshops, with a total of 21 clients. Staff and clients at both services reported positive appraisals of the achievement of cultural respects. Strategies included: being grounded in a social view of health, including advocacy and addressing social determinants; employing Aboriginal staff; creating a welcoming service; supporting access through transport, outreach, and walk-in centres; and integrating cultural protocol. Barriers included: communication difficulties; racism and discrimination; and externally developed programs. Service-level strategies were necessary to achieving cultural respect. These strategies have the potential to improve Aboriginal and Torres Strait Islander health and wellbeing. Primary health care's social determinants of health mandate, the community controlled model, and the development of the Aboriginal and Torres Strait Islander health workforce need to be supported to ensure a culturally respectful health system.

PTH-077 Geographical Mapping Of Hepatitis C Infection In North East Scotland Using A Geographical Information System (gis)

IntroductionChronic HCV infection affects around 37,500 people in Scotland. A Geographical Information System (GIS) allows exploratory data analysis (EDA), mapping and visualisation of geographical data. GIS can be used to...

Undergraduates' self-reported clinical experience, confidence and perspectives of hospital and outreach paediatric dentistry: a three-year multi-centre evaluation

A variety of educational approaches exist within U.K. dental schools, and institutions are constantly striving to improve the quality of their graduates. This study aimed to evaluate the self-reported confidence in, and clinical exposure to, paediatric dentistry at three U.K. dental schools (Liverpool, Manchester and Sheffield) over a three year period. Seventy-five percent of final year BDS undergraduates at the three dental schools completed an anonymous questionnaire capturing student self-reported clinical experience in seven core paediatric dentistry treatment skills, both in hospital and outreach settings. Visual analogue scales were used to record self-assessed confidence levels in aspects of paediatric dentistry and students were also asked to provide a written reflection of both their hospital and outreach placements. The results revealed that despite the variety of educational approaches taken, undergraduates reported very similar levels of clinical experience and confidence. Significant interschool differences in student experience were found with respect to the management of carious primary molars, believed to be a result of individual schools favouring different treatment regimes. Although outreach placements were seen as essential for gaining adequate student experience, the need to improve the consistency of teaching between hospital and outreach centres was highlighted. The study also emphasises the need to take care when using clinical targets in undergraduate teaching and identifies the potential benefits of undergraduate training in inhalation sedation. Finally, despite changes to the paediatric programmes with respect to dental trauma management, students remained lacking in confidence suggesting the need for further development.

Challenges and frugal remedies for lowering facility based neonatal mortality and morbidity: a comparative study.

Millennium development goal target on infant mortality (MDG4) by 2015 would not be realised in some low-resource countries. This was in part due to unsustainable high-tech ideas that have been poorly executed. Prudent but high impact techniques could have been synthesised in these countries. A collaborative outreach was initiated to devise frugal measures that could reduce neonatal deaths in Nigeria. Prevailing issues of concern that could militate against neonatal survival within care centres were identified and remedies were proffered. These included application of (i) recycled incubator technology (RIT) as a measure of providing affordable incubator sufficiency, (ii) facility-based research groups, (iii) elective training courses for clinicians/nurses, (iv) independent local artisans on spare parts production, (v) power-banking and apnoea-monitoring schemes, and (v) 1/2 yearly failure-preventive maintenance and auditing system. Through a retrospective data analyses 4 outreach centres and one “control” were assessed. Average neonatal mortality of centres reduced from 254/1000 to 114/1000 whilst control remained at 250/1000. There was higher relative influx of incubator-dependent-neonates at outreach centres. It was found that 43% of mortality occurred within 48 hours of presentation (d48) and up to 92% of d48 were of very-low birth parameters. The RIT and associated concerns remedies have demonstrated the vital signs of efficiency that would have guaranteed MDG4 neonatal component in Nigeria.