Public Secondary Health Facilities Research Articles

Health worker motivation to deliver quality care in western Nigeria

Abstract Background Motivation of health service providers (HSPs) is an important factor for delivering quality services and achieving client satisfaction. Understanding the motivation to perform is therefore important in providing evidence for interventions. Objective To assess motivation to deliver quality service among antenatal care service providers in public secondary health facilities in western Nigeria. Method A cross-sectional, facility-based study was conducted using a validated, semi-structured self-administered questionnaire. In all, 280 HSPs were recruited using multistage sampling method. Data were analyzed using Epi-info statistical software. Inferential statistics such as chi square and binary regression were applied. Results Factors with high mean scores as motivators were those related to individual aspects especially conscientiousness, cooperativeness, timeliness and attendance, and appreciation from patients. Factors with the lowest mean scores were those linked with work organization such as limited resources (insufficient staff and equipment) and poor promotion processes. Overall, only 69 (24.5%) of HSPs reported that they were motivated to deliver quality care. Predictors of motivation were nonphysician cadre and longer years of service. Nurse/midwives, lab scientists/lab technicians, and pharmacist/pharmacy technicians were all more likely to be motivated than physicians. HSPs with more than 10 years experience on their current job were almost 9 times more likely to be motivated than those who had spent a lesser duration [odds ratio (OR), 1.14; 95% CI, 1.06–1.22]. Conclusion HSPs were not motivated to deliver quality care, especially physicians and those who had spent lesser duration on their current job. Interventions should focus on the provision of adequate resources and improving promotion process.

Barriers to the provision of respectful maternity care during childbirth by midwives in South-West, Nigeria: Findings from semi-structured interviews with midwives

BackgroundDisrespect and Abusive Care (DA&C) of women in health facilities during childbirth is a topic of growing concern globally. Given that DA&C is a violation of women’s basic rights and a deterrent to facility-based maternity services for women. In Nigeria, limited evidence exists on barriers to the provision of Respectful Maternity Care (RMC), especially in South-West, Nigeria. AimThis study aimed to explore the barriers to the provision of Respectful Maternity Care (RMC) during childbirth by midwives in selected health facilities in Lagos State, Nigeria. MethodologyThe research used an Exploratory Descriptive Research Design. Data was collected through semi-structured individual interviews. Data analysis was done following Burns and Clarke’s thematic method. Twenty midwives were purposively selected from two public secondary health facilities. FindingsThe findings of this study revealed the barriers to the provision of RMC are diverse and interwoven. The study highlighted health system factors, health provider factors and client factors as barriers challenging the provision of RMC. Health system factors include physical structure of the labour ward, shortage of staff, shortage of resources, lack of motivation, hospital policy and poor working conditions. Health provider factors identified were midwives’ personal beliefs, individual personalities, the poor orientation of professional staff, and poor collaborations among professionals. The client factors were women’s/relations attitudes and unmet expectations. ConclusionTraining midwives and others on RMC without addressing deficiencies in the health care system will not achieve the desired goals of RMC. Encouraging teamwork, trust-building, collaboration, accountability and effective communication among health workers, policymakers, stakeholders and women will further promote RMC.

Knowledge, attitude and willingness to accept the RTS,S malaria vaccine among mothers in Abuja, Nigeria

Malaria constitutes a major public health challenge and Nigeria contributes hugely to the global burden. In recent times, there has been a massive scale up of all interventions for evident impact. One of the novel preventive measures being considered is the RTS,S malaria vaccine. The objective of this study was to assess mothers’ knowledge, attitude, and practices to malaria and its prevention as well as mothers’ willingness to accept the RTS,S/AS01 malaria vaccine. A cross-sectional study design was used to administer questionnaires to 180 mothers within six public secondary health facilities in Abuja, Nigeria. About 30% (36/180) of respondents were aware of malaria vaccines but only four percent (7/180) had heard of RTS,S. Young maternal age (OR, 2.4; 95% CI, 1.09-5.28; P = 0.03), self-employment (OR, 2.55; 95% CI, 1.04-6.28; P = 0.04) and formal employment (OR, 3.74; 95% CI, 1.17-11.99; P = 0.03) were associated with no prior knowledge of malaria vaccine. Ninety-one percent (163/180) had a positive attitude to malaria vaccine and 98% (176/180) were willing to allow their child(ren) to be immunized with RTS,S despite the efficacy of the vaccine, route of administration and number of doses. We concluded that knowledge of malaria preventive measures does not correlate with knowledge of RTS,S. Although willingness to accept RTS,S is high, consistent targeted messaging on RTS,S would be required to improve community knowledge and attitude prior to implementation to ensure maximum uptake.

Determinants of perinatal mortality in public secondary health facilities, Abuja Municipal Area Council, Federal Capital Territory, Abuja, Nigeria.

Introductionin Nigeria, perinatal mortality rate remains high among births at the health facility. Births occur majorly at the secondary healthcare level in Abuja Municipal Area Council (AMAC) of the Federal Capital Territory (FCT). Identifying factors influencing perinatal deaths in this setting would inform interventions on perinatal deaths reduction. We assessed perinatal mortality and its determinants in public secondary health facilities in AMAC.Methodsdelivery and neonatal data from two selected public secondary health facilities between 2013 and 2016 were reviewed and we extracted maternal socio-demographics, obstetrics and neonatal data from hospital delivery, newborns´ admissions and discharge registers. Data were analyzed using descriptive statistics and Cox proportional hazard models (α = 5%).Resultsperinatal mortality rate was 129.5 per 1000 births. Asphyxia 475 (34.0%), neonatal infection 279 (20.0%) and prematurity 242 (17.3%) accounted for majority of the 1,398 perinatal deaths. Unbooked status [aHR = 1.8 (95% CI 1.4 - 2.2)], antepartum haemorrhage [aHR = 2.8 (95% CI 1.2 - 6.7)], previous perinatal death [aHR = 2.3 (95% CI 1.7 - 3.1)] and maternal age ≥ 35 years [aHR= 1.4 (95% CI 1.0 - 1.8)] were associated with increased risk of perinatal death.Conclusionperinatal mortality in the studied hospitals was high. Determinants of perinatal death were unbooked antenatal care (ANC) status, antepartum haemorrhage, previous perinatal death and high maternal age. Reducing perinatal deaths would require improving antenatal care attendance with healthcare staff identifying and targeting women at risk of pregnancy complications.

Assessment of laboratory capacity of public secondary health facilities in performing assay of selected epidemic-prone diseases in Oyo State, Nigeria

This study assessed the capacity of public secondary facility-based laboratories in conducting diagnostic tests for selected epidemic-prone diseases in Oyo State, Nigeria. A descriptive cross-sectional study was conducted in 17 secondary facility-based laboratories in Oyo State. Capacity was assessed on a 100-point scale in which scores were rated low (≤49%), fair (50–79%) and good (≥80%). Diagnostic testing capacity for bacterial meningitis, cholera, and measles was “low” in all the laboratories. The reasons reported for laboratories not conducting diagnostic tests for the selected diseases included inadequate instruments, unavailable reagents, and clinicians' failure to request those diagnostic tests. Laboratory capacity to perform diagnostic tests for the selected diseases was low in Oyo State secondary hospitals. There is a need for the provision of modern instruments and reagents, as well as clinician laboratorian quality assurance programs, to improve diagnostic services relating to the selected diseases.

The Influence of National Health Insurance on Medication Adherence Among Outpatient Type 2 Diabetics in Southwest Nigeria.

Purpose:Medication adherence (MA) is a challenge among patients with chronic diseases worldwide. Little has been reported on the influence of National Health Insurance Scheme (NHIS) on MA among diabetic patients in Nigeria.Objective:To assess the influence of NHIS on MA among outpatient type 2 diabetics in 2 public secondary health facilities in Southwest Nigeria.Method:A cross-sectional study involving 110 consecutively selected outpatient type 2 diabetics (insured, n = 42; uninsured, n = 68) was carried out. The patients’ perceptions of care and the influence of drug cost on MA between the insured and uninsured were compared. The patients’ perceptions of care were assessed using a 25-item pretested questionnaire. The MA was measured using the Morisky MA-8 scale. The use of oral antidiabetic drugs (OADs) was evaluated using a medical chart review. Information about patients’ sociodemographics, year of diagnosis, comorbidities, and types of OADs prescribed was retrieved from the medical records. Descriptive statistics were used for data presentation. A Pearson χ2 was used for test of associations. P values < .05 were considered significant.Results:Majority of the respondents (68 [61.8%]) were uninsured. The insured and the uninsured patients differed in their perceptions of the adequacy of time used by pharmacists for medication counseling (P < .0005). The MA between the groups also differs (P = .0002). The monthly drug cost for OADs was significantly associated with MA (P = .037).Conclusion:The study concluded that the NHIS may positively influence MA among diabetic patients. The drug cost may have contributed significantly to the difference in MA between the groups. More time should be devoted to the counseling of the uninsured patients.

Factors Influencing Exclusive Breastfeeding in Early Infancy: A Prospective Study in North Central Nigeria.

To determine the association between prenatal exclusive breastfeeding intentions and exclusive breastfeeding (EBF) and explore other factors associated with EBF until 3 months postpartum among mothers residing in suburban parts of the Federal Capital Territory, Abuja Nigeria. This longitudinal observational study involved the recruitment of 210 pregnant women who were prospectively followed until 3 months postpartum. Participants were recruited from antenatal clinics attached to four separate public secondary health facilities located in the suburban parts of Abuja. Cox regression hazards model was used to determine the risk of EBF cessation at 3 months postpartum. Over 70.0 % of women had strong intention to exclusively breastfeed. The risk of exclusive breastfeeding cessation was significantly lower in women with strong exclusive breastfeeding intentions (HR 0.87, 95 % CI 0.8-0.95). Other risk factors for cessation of exclusive breastfeeding were pre-lacteal feed administration (HR 2.93 95 % CI 1.49-5.77) and mode of delivery (HR 0.17 95 % CI 0.04-0.67). Higher maternal age (≥35 years), religion (Muslim) and having an unplanned pregnancy lowered the likelihood of having a strong intention to exclusively breastfeed an infant. Prenatal exclusive breastfeeding intention was a strong predictor of exclusive breastfeeding. Intentions to EBF were further explained by maternal characteristics. Effective promotion of exclusive breastfeeding during prenatal period should also target factors influencing breastfeeding intentions. Additional research is warranted into the influence of maternal attitudes and self-efficacy about breastfeeding on breastfeeding intentions and practice.

The use of artemisinin-based combination therapies (ACTs) in public secondary health facilities in Lagos, Nigeria

The objectives of the study were to assess the prescription pattern of Artemisinin Combination Therapies (ACTs) in uncomplicated malaria and the knowledge, attitude and practice of physicians as regards use of ACTs in the outpatient clinics of public secondary health facilities in Lagos State. All the ten General Hospitals under the Lagos State Health Management Board were studied and classified as either rural or urban. 1878 retrospective antimalarial prescriptions of outpatients between March, 2005--March, 2006 were systematically sampled and questionnaires were distributed to prescribers in April--May, 2006. Prescription assessment was based on the recent Nigerian National Antimalarial Treatment Policy and WHO/INRUD drug use indicators. The percentage of prescriptions containing ACTs was found to be rather small (5.9%) inspite of the high proportion (59.2%) of prescribers who were favourably disposed to the National antimalarial policy change from Chloroquine to ACTs as first line. There was no statistically significant difference in frequency of ACTs prescription between the rural and urban health facilities. The prescription of Artemisinin derivatives as monotherapy was 18.2%. The prescription of Chloroquine was found to be more predominant, (48.8%) in all the health facilities. Despite the national policy change from Chloroquine to (ACTs) as the first line antimalarial, their use in the public secondary health facilities in Lagos State does not reflect this policy change and it appears that Chloroquine still remains the choice antimalarial drug.