Trends in the use of skilled birth attendants among women of reproductive age in a resource-limited setting

Background: Although there has been growing awareness on the need for professional assistance at delivery, and this has improved health-seeking behavior and the use of antenatal care (ANC) of pregnant women, presenting for ANC does not directly imply that a woman would use a skilled birth attendant (SBA) at delivery. This study analyzed the trend in the use of SBAs at delivery among Nigerian reproductive women from 2007 to 2017. Materials and Methods: The study used the United Nations Children’s Fund, Multiple Indicator Cluster Surveys data for the years 2007 (n = 1021), 2011 (n = 2927), and 2016/2017 (n = 4155). Multivariate logistic regression was used to determine the relationship between the use of SBAs and demographic characteristics of women aged 15–49 years in Nigeria. Results: There was a significant decline in the utilization of SBAs at delivery from 82.7% in 2007 to 71.8% in 2016/2017 (P < 0.001). There was a decline in the proportion of doctors and nurses/midwives as birth attendants from 28.3% and 54.4% in 2007 to 22.8% and 49.0% in 2016/2017, respectively (P < 0.001), whereas the use of traditional birth attendants increased from 5.2% to 8.0% during the periods (P = 0.003). Urban residence [adjusted odds ratio (AOR)=1.32, 95% confidence interval (CI)=1.18–1.47, P < 0.01], higher maternal age (AOR=1.49, 95% CI=1.30–1.70; P < 0.01), and education attainment (AOR=3.78, 95% CI=3.39–4.22; P < 0.001) were associated with higher odds of the utilization of SBAs. Conclusion: There is a need for intervention programs for women in rural areas and women with a low level of education and lower maternal age. This will further reduce the maternal mortality ratios of the country.

Enrollees’ knowledge, satisfaction, and barriers to uptake of National Health Insurance Scheme in north-central Nigeria

Background: Enrollees’ knowledge, behavior, and perception of health insurance substantially influence a decision about the uptake of sustainability of the program. This study assessed enrollees’ knowledge, satisfaction, and barriers to the National Health Insurance Scheme (NHIS) uptake in Benue State, Nigeria. Materials and Methods: The study was a descriptive survey conducted among hospital clients enrolled in the formal sector program of the health insurance scheme in Makurdi, Benue State, Nigeria. A structured questionnaire was used to collect respondents’ demographic information and data related to the knowledge, satisfaction, and barriers to the uptake of NHIS in Nigeria. IBM-SPSS version 25.0 was used to analyze the data. Results: The study comprised 53.2% males, and 46.8% were females. The majority (82.9%) of the enrollees were aware of the objectives of the NHIS, but only 33.4% were aware of their benefits as enrollees and only 56.0% were satisfied with NHIS services. Factors that significantly influenced enrollees’ satisfaction include sex, age, education level, income, and knowledge of enrollees’ entitlements (P < 0.05), but the family size and knowledge of the objectives of the NHIS were not significantly associated with the level of satisfaction (P > 0.05). The most common barriers to the uptake of the NHIS include cultural and religious norms (67.4%) and poor social infrastructures (60.6%). Conclusion: This study revealed that the enrollees had poor knowledge of their entitlements for enrolling in the NHIS and a low level of satisfaction. There is a need for more awareness interventions across Nigeria to sensitize citizens of the scheme’s importance, objectives, and benefits.

Expanding access to viral load testing in Nigeria; the impact of third party logistics

Background: Access to viral load testing in Nigeria remains a key challenge in achieving the Joint United Nations Program on HIV/AIDS (UNAIDS) 90:90:90 targets in the fight against HIV/AIDS. This study investigates the impact of 3 party logistics (3PL) on expanding access to viral load testing.Methods: This exploratory, case study research was carried out in Abuja in December, 2018, using in-depth interview method. Open-ended questions were used to interview nine staff from the three polymerase chain reaction laboratories in Federal Capital Territory. The audios of interviews were recorded and transcribed on paper. The data was analyzed using SPSS version 24.Results: This study revealed that the adoption of 3PL services has helped to overcome major challenges of viral load testing such as late delivery of samples, late collection of results, and rejection problems; thereby reduced sample rejection frequencies, increased efficiency, reduced turnaround time and ease viral load testing processes. Though the adoption of 3PL has helped to overcome major challenges of viral load testing, however, the challenges still facing viral load testing include the 3PLs bringing samples at any time-even at closing hours, not delivering results to facilities on time after pickup, poor medical backgrounds and inability of 3PLs to enforce instructions on facilities. However, respondents expressed satisfaction with the services of the 3PLs.Conclusions: The findings of this study revealed that the adoption of 3PL service into viral load transport logistics has positive impacts on the process. However, only one of the laboratories uses two 3PL providers while other two use only one.

Respiratory Burst Enzymes and Oxidant-antioxidant Status in Nigerian Children with Sickle Cell Disease.

Aim: To measure respiratory burst enzymes, pro-oxidants, antioxidants and red cell indices in Nigerian children with sickle cell disease (HbSS) below five years of age and compared with apparently healthy children with normal haemoglobin (HbAA). Method: A total of 45 subjects were recruited which included 23 children (age range 10 – 48 months) with HbSS and 22 children (age- and sex- matched) with HbAA. Blood samples were collected and red cell indices were determined using automated haematology analyser while serum superoxide dismutase (SOD), glutathione peroxidise (GSH-Px) and myeloperoxidase (MPO) activities were measured using ELISA kits. Serum malondialdehyde (MDA), hydrogen peroxide (H2O2), glutathione S transferase (GST), catalase (Cat), xanthine oxidase (XO) and glutathione (GSH) were measured with colorimetric techniques. MPO, SOD and Cat represented respiratory burst enzymes; MDA, H2O2 and XO were measured as pro-oxidants while GSH, GST and GSH-Px were the measured antioxidants. Results: Mean concentration of malondialdehyde was significantly reduced (5.56±1.12nmol/L vs. 6.46±1.11nmol/L, P=.04) in HbSS children compared with HbAA children. Similarly, mean serum activity of myeloperoxidase in HbSS children was significantly reduced compared with HbAA children (66.12±13.34U/mL vs 77.02±13.54U/mL, P=.03). However, there were no significant differences in mean concentration of serum glutathione, hydrogen peroxide; serum activities of glutathione peroxidase, catalase, superoxide dismutase, xanthine oxidase and glutathione S transferase in HbSS children compared with HbAA children Conclusion: HbSS children in this population did not demonstrate raised oxidative stress.