Comparative assessment of infection prevention and control practice among maternity unit health workers in public and private secondary health facilities in Kaduna state, Nigeria

OBJECTIVES: Infection prevention and control (IPC) practice in health facility (HF) is abysmally low in developing countries, resulting in significant preventable morbidity and mortality. This study assessed and compared health workers' (HWs) practice of IPC strategies in public and private secondary HFs in Kaduna State. MATERIAL AND METHODS: A cross-sectional comparative study was employed. Using multistage sampling, 227 participants each were selected comprising of doctors, midwives, and nurses from public and private HF. Data were collected using interviewer-administered questionnaire and observation checklist and analyzed using bivariate and multivariate analysis. Statistical significance determined at P < 0.05. RESULTS: The practice of infection prevention was poor. Overall, 42.3% of the HWs did not change their gowns in-between patients, with the significantly higher rates in 73.1% of private compared to 42.3% of public HF workers (P < 0.001). In addition, 30.5% and 10.1% of HWs do not use face mask and eye goggle, respectively, when conducting procedures likely to generate splash of body fluids, however, there was no significant difference in these poor practices in public compared to private HFs. The mean IPC practice was 51.6 ± 12.5%, this was significantly lower among public (48.8 ± 12.5%) compared to private (54.5 ± 11.9%) HF workers (P < 0.0001). Private HF workers were 3 times more likely to implement IPC interventions compared to public HF workers. CONCLUSION: IPC practice especially among public HF workers was poor.

Maternity waiting Home-use and associated factors among mothers in northwest Ethiopia, The application of the integrated behavioral model

Background: Data-informed decision making is influenced by organizational, technical, and behavioral factors.Behavioral factors are the major contributing factors for data-informed decision-making practices. This study aimed to explore health workers' perceptions of data-informed decision making at primary health care units in Awi zone. Method: A cross-sectional qualitative study was undertaken to explore health workers' perceptions on the barriers of health data-informed decision-making practices. Eleven healthcare workers were purposively selected from primary hospitals, health centers and health posts. Medical doctors, nurses, midwifes and health extension workers were selected as key informants for the in-depth interview. The selected healthcare workers were asked about their perceptions that affect health data use practices. The data obtained was analyzed through thematic analysis using Open Code software. Analysis was performed using three themes namely, organizational, behavioral, and technical barriers of data-informed decision making. Results: All the health care workers including health extension workers utilized a data-informed decision-making practice at least once during their point of care. Five of the eleven key informants reported their data-informed decision-making practice as reviewing quality of facility data, while none of them reported data-informed decision-making practices for their monthly performance monitoring. Behavioral factors included negligence, workarounds, and skill gaps. Organizational factors included staff turnover and shortage of recording tools. Technical factors included high workloads which lead to data error and paper-based systems were considered major barriers to data-informed decision-making practices. Conclusion: Data-informed decision-making practices were low at primary health care units. Behavioral, organizational, and technical factors contributed to the decreased use of data. [Ethiop. J. Health Dev. 2022;36(2):000-000]

Sex-ratio at birth in Nigeria: A demographic perspective

The study attempts at estimating the sex-ratio at birth in Nigeria. The study focuses on demographic surveys with complete maternity histories, including some 0.50 million births. It compares results with published estimates from births in health facilities and a few data from vital registration, including some 1.13 million births. Results from demographic surveys give an estimate of about 106 boys for 100 girls. There were no significant variations by large region in the country, and no significant trend over the years (1990-2018). Published estimates provided a similar value (106.2), with somewhat lower value in health facilities (105.3), and somewhat higher values in local vital registration (106.8), and major variations among available studies. Despite uncertainty, Nigeria appears to have higher sex-ratios than most African countries, with the exception of Ethiopia, and higher values than its five neighboring countries. Reasons for these high values of the secondary sex-ratio are discussed. (Afr J Reprod Health 2022; 26[4]: 92-97).

Intention to Use Maternal Waiting Homes and Related Factors among Pregnant Women in Metu Woreda, Western Ethiopia

BACKGROUND: Maternity Waiting Homes are houses built in the healthcare settings that lodge pregnant women in their term state of pregnancy to prevent labor and delivery-related complication. This study aimed to estimate the extent of pregnant women's intention to use Maternal Waiting Homes and identify its associated factors in Metu Woreda, Western Ethiopia. METHODS: A community-based cross-sectional study was conducted from March 1-30, 2018. We used a systematic sampling method to select the study participants and Binary logistic regression analysis was used to identify factors associated with the intention of the women to use Maternal Waiting Homes. RESULTS: A total of (97%) of respondents' questionnaires were found complete and analyzed for this study. Almost half (48.8%) of the pregnant women who participated in the study were planned to use Maternal Waiting Homes in their prospective delivery. Based on multivariate logistic regression analysis; being illiterate and/or less educated in their educational status, having a history of using Maternal Waiting homes, and receiving a number of times antenatal care services were found statistically significantly associated with intention of the women to use Maternal Waiting Homes. CONCLUSION: It is trivial that more than half of the pregnant women who participated in the study were unintended to use Maternal Waiting Homes. Educational status, a number of times attending antenatal care services and experience of using Maternal Waiting Homes were found statistically significantly associated with women's intention to use Maternal Waiting Homes

Comparative assessment of infection prevention and control practice among maternity unit health workers in public and private secondary health facilities in Kaduna state, Nigeria

Objectives: Infection prevention and control (IPC) practice in health facility (HF) is abysmally low in developing countries, resulting in significant preventable morbidity and mortality. This study assessed and compared health workers' (HWs) practice of IPC strategies in public and private secondary HFs in Kaduna State. Material and Methods: A cross-sectional comparative study was employed. Using multistage sampling, 227 participants each were selected comprising of doctors, midwives, and nurses from public and private HF. Data were collected using interviewer-administered questionnaire and observation checklist and analyzed using bivariate and multivariate analysis. Statistical significance determined at P < 0.05. Results: The practice of infection prevention was poor. Overall, 42.3% of the HWs did not change their gowns in-between patients, with the significantly higher rates in 73.1% of private compared to 42.3% of public HF workers (P < 0.001). In addition, 30.5% and 10.1% of HWs do not use face mask and eye goggle, respectively, when conducting procedures likely to generate splash of body fluids, however, there was no significant difference in these poor practices in public compared to private HFs. The mean IPC practice was 51.6 ± 12.5%, this was significantly lower among public (48.8 ± 12.5%) compared to private (54.5 ± 11.9%) HF workers (P < 0.0001). Private HF workers were 3 times more likely to implement IPC interventions compared to public HF workers. Conclusion: IPC practice especially among public HF workers was poor. Keywords: Hospital-acquired infection, Infection prevention and control, Maternity unit, Practice

Evaluation of protocol of management of morbidly adherent placenta in maternity Zagazig university hospital

Background: Morbidly adherent placenta (MAP) defines the abnormal adherence of the placenta to the underlying uterine wall. It has a rising incidence world-wide. The risk of placental abnormalities increases in the presence of uterine scars due to cesarean delivery or gynecologic procedures. It may lead to massive obstetric hemorrhage resulting in serious complications such as DIC, transfusion related complications. Aim: Evaluation of protocol of management of patients with morbidly adherent placenta at Maternity Zagazig University Hospital and its effect on pregnancy outcome to find the best method of management to decrease associated morbidity and mortality.Patients and methods: This cohort study conducted on 120 patients diagnosed as having morbidly adherent placenta and were admitted to Zagazig University Hospitals.Results: In our study there were 48 cases (40%) managed by CS only and 72 cases (60%) managed by hysterectomy.Conclusion: well-planned caesarean hysterectomy with placenta left in situ adopting multidisciplinary approach is the recommended management option for MAP

The differential effect of the free maternity services policy in Kenya

Background: The Government of Kenya introduced the free maternity services (FMS) policy to enable mothers deliver at a health facility and thus improve maternal health indicators. Aim: The aim of this study was to determine if there was a differential effect of the policy by region (sub-county) and by facility type (hospitals vs. primary healthcare facilities [PHCFs]). Setting: The study was conducted in Nyamira County in western Kenya. Methods: This was an interrupted time series study where 42 data sets (24 pre- and 18 post-intervention) were collected for each observation. Monthly data were abstracted from the District Health Information System-2, verified, keyed into and analysed by using IBM-Statistical Package for the Social Sciences (SPSS-17). Results: The relative effect of thepolicy on facility deliveries in the county was an increase of 22.5%, significant up to the 12th month (p < 0.05). The effect of the policy on deliveries by region was highest in Nyamira North and Masaba North (p < 0.001 up to the 18th month). The effect was larger (46.5% vs. 18.3%) and lasted longer (18 months vs. 6 months) in the hospitals than in the PHCFs. The increase in hospital deliveries was most significant in Nyamira North (61%; p < 0.001). There was a medium-term effect on hospital deliveries in Borabu (up to 9months) and an effect that started in the sixth month in Manga. The relative effect of the policy on facility deliveries in PHCFs was only significant in Nyamira North and Masaba North (p < 0.001). Conclusion: The effect of the FMS policy was varied by region (sub-county) and by facility type

Trends of and factors associated with cesarean section related surgical site infections in Guinea

Since the adoption of free obstetric care policy in Guinea in 2011, no study has examined the surgical site infections in maternity facilities. The objective of this study was to assess the trends of and factors associated with surgical site infection following cesarean section in Guinean maternity facilities from 2013 to 2015. This was a retrospective cohort study using routine medical data from ten facilities. Overall, the incidence of surgical site infections following cesarean section showed a declining trend across the three periods (10% in 2013, 7% in 2014 and 5% in 2015, P<0.001). Women who underwent cesarean section in 2014 (AOR: 0.70; 95%CI: 0.57-0.84) and 2015 (AOR: 0.43; 95%CI: 0.34-0.55) were less likely to develop surgical site infections during hospital stay than women operated in 2013. In the contrary, women with comorbidities were more likely to experience surgical site infection (AOR: 1.54; 95% CI: 1.25-1.90) than those who did not have comorbidities. The reductions achieved in 2014 and 2015 (during the Ebola outbreak) should be sustained in the post-Ebola context

Audit of cases with uterine rupture: a process indicator of quality of obstetric care in Angola

Audit of uterine rupture (UR) used as a process indicator, can identify factors considered avoidable to improve future quality of obstetric care. Records of UR cases at a referral maternity in Luanda were studied retrospectively (n=43) and prospectively (n=67) including basic obstetric information, maternal and foetal outcome, duration of labour, time interval between diagnosis and intervention, drugs used, type of delivery and intervention, surgical procedures and complications. A clinical estimation of avoidability was based on this information. Prevalence of UR was 4.9%. Maternal case fatality rate was 14% and early perinatal mortality 71%. Women with previous Caesarean Section (CS) constituted 28%, grand multiparous women 44% and primiparous women 6%. Uterotonic treatment was given in 36%. Avoidability was estimated to 65%. Regular morbidity-oriented audits with analysis of clinical manage-ment reveal weaknesses in obstetric care and may serve as an instrument for future improvement (Afr. J. Reprod. Health 2010; 14[2]:55-62)