Knowledge; Attitude; and Infection Control Practices of two Tertiary Hospitals in Port-Harcourt; Nigeria

Background: Surgical site infections (SSIs) are a significant cause of morbidity; emotional stress and financial cost to the affected patients and health care institutions; and infection control policy has been shown to reduce the burden of SSI in several health care institutions. This study assessed the effects of the implementation of the policy in a tertiary hospital in Port Harcourt; Nigeria. Materials and Methods: A cross-sectional; comparative study design was used for the study; with data collected using a structured questionnaire and guided observation of doctors and nurses involved in the management of patients that had caesarean sections in two comparable tertiary hospitals in Port Harcourt-the University of Port Harcourt Teaching Hospital (UPTH) and the Braithwaite Memorial Specialist Hospital (BMSH). Results: There were no statistically significant differences in the designations and length of practice of the respondents in both hospitals (P = 0.77). However; 63.64 of the respondents in UPTH were aware of the infection control committee; compared with none in BMSH. The appropriate timing for the administration of prophylactic antibiotics; and for the removal of the hair at the incision site were observed by 57.58 of the respondents in UPTH were aware of the infection control committee; compared with none in BMSH. The appropriate timing for the administration of prophylactic antibiotics; and for the removal of the hair at the incision site were observed by 57.58 and 69.69 respectively of the respondents in UPTH; compared with 22.86 (P = 0.00) and 0.00 (P = 0.02) in BMSH. The reasons given by the respondents in UPTH for nonadherence to the infection control policy include poor supervision (39.39) and lack of in-service training (21.21); while the respondents in BMSH gave reasons that include inadequate supply of consumables (34.29) and absence of a hospital's policy on infection control (22.88). Conclusion: The implementation of the infection control policy resulted in some improvements in certain infection control practices

Does the Nigeria Health Care System Need a Primary Gate-Keeper?

Background: The World Health Organization (WHO) is presently focusing more attention on how health systems will become more effective and efficient. Introduction of primary gate-keepers into healthcare systems by some countries has revolutionized their healthcare system. It clearly alters the channels by which patients receive care particularly in countries where specialists are in short supply. Aim: To discuss the role of primary gate-keeping in healthcare systems and to use the experience of some countries with and without a primary gate-keeper function to evaluate the Nigerian healthcare system. Methods: A search of some standard books and relevant articles on primary 'gate-keeping' and healthcare systems using the Google and Yahoo search engine facilities helped to gain access to general information on the title. We also searched the EMBASE and OVIDMEDLINE data bases using the HMIC search strategy template. Results: Healthcare services are delivered within three distinct but increasingly overlapping and fluid subsystems namely; primary; secondary and tertiary care. In the UK and Netherlands healthcare systems; the general practitioner (GP) serves as the primary gate-keeper to other professionals. On the contrary; France; Germany and Nigeria don't have effective primary gate-keeping system. However; in Nigeria family physicians run the general out-patient clinics and serve as a point of first contact and referrals. Conclusion: Gate-keepers are mainly geared towards helping a healthcare system to achieve better health levels. Unlike in the UK and Netherlands; there is no effective primary gate-keeping in the Nigerian healthcare system. Government should make efforts to address this anomaly to allow every person have effective and efficient healthcare services