Mothers' perception of COVID-19 infection in their under-five children presenting in a tertiary health institution in South-East Nigeria and associated factors

Background: Maternal attitude to health-seeking behavior of their under-five children in the COVID-19 pandemic is not well-known. Objectives: This study is aimed at determining mothers' perception of COVID-19 pandemic among their under-five children and associated factors. Methodology: This is a prospective and observational study carried out in two health institutions in South-East Nigeria. Results: Most subjects, 243 (65.3%) noted that someone without showing symptoms of COVID-19 could transmit the virus. Of the mothers of children under-five, 271 (72.8%) highlighted the possibility of COVID-19 infection in the under-five. A small number of participants 53 (14.2%) showed awareness that people should cough into their elbows as a way of preventing the transmission of COVID-19. A small number of participants, 160 (43.0%) had a good perception of COVID-19. Majority of mothers who were married, 148 (44.7%) showed a good perception of COVID-19 when compared with those who were single, 12 (29.3%); however, this is not significant, (χ2 = 3.550, P = 0.060). A large number of participants who have attained tertiary education, 92 (48.9%) had a good perception of COVID-19 which is higher than that seen in mothers with secondary education 68 (37.0%) (χ2 = 5.444, P = 0.020). Participants who were 30­34 years had 1.8 times higher odds of good perception of COVID 19 compared with mothers who were more than 35 years (adjusted odds ratio = 1.803, 95% confidence interval = 1.026­3.170). Conclusion: Although most mothers affirm that a child could be infected by COVID-19, a small number of them actually had a good perception of COVID-19 infection. Good perception of COVID-19 among the under-five is enhanced by the high level of education and age of 32­34 years.

Spatial Differences in Quality of Maternal Health Service in Primary Health Centers of Enugu State, Nigeria.

Aim: The aim of the study was to determine how adequate were the resources, (equipment and personnel), process (client-provider interaction), and outcome components of quality of maternal health service in urban and rural primary health centers of Enugu state, Nigeria. Study Design: Cross-sectional analytical study design. Place and Duration of Study: Primary health centers in Enugu State, Nigeria, between January and March 2013. Methodology: A three stage sampling method was used to select 540 clients in18 of 440 primary health centers in the state. The clients were women who attended antenatal and postnatal care in the health centers. Outcome measure was clients true satisfaction with maternal health service also denoted as satisfaction index. It was assessed by proportion of clients who were satisfied with antenatal, and postnatal care, were ready to use the health centers again, and willing to recommend them to others for same services. Results: No health center had adequate equipment, 16.7% of health centers had adequate health manpower and 16.7% had good client provider interaction. Only a minor proportion of clients, (urban 7%; rural 24.1%) delivered in the health centers. On part of clients, 64.8% in urban were truly satisfied, as compared to 75.6% in rural. Predictors of clients true satisfaction included being a client in urban, (AOR=0.6, 95% CI: 0.4- 0.9), client unmarried, (AOR=0.3, 95% CI: 0.1- 0.5), and being unemployed/housewife, (AOR=2.0, 95% CI: 1.3- 4.5). Conclusion: The structure and process components of quality of maternal health service in primary health centers in the study area were deficient. Also, utilization of health centers for delivery services was poor. The clients of maternal health service seem to focus more on providers of healthcare and their interactions with them than the health system and its deficiencies hence were easily satisfied with the services received. To reduce the maternal death burden in Nigeria there is need for adequate attention on rural areas, the primary health care system and the provision of client oriented health services at all levels of care. More health workers should be employed, and more equipment supplied in-order to improve the quality of maternal health service in the primary health centers.

Perception about Working in Rural Area after Graduation and Associated Factors: A Study among Final Year Medical Students in Medical Schools of Southeast Nigeria.

Aims: Aim of study was to determine the perception of rural medical practice among final year medical students in medical schools of southeast Nigeria and the associated factors. Study Design: Descriptive cross-sectional study. Place and Duration of Study: The six medical schools in southeast Nigeria, between March and May 2014. Methodology: All the final year medical students in southeast Nigeria were recruited and were eligible for voluntary participation in the study. The students were interviewed using a pretested, self-administered questionnaire. Data analysis was done using STATA statistical software; version 13 and level of significance was determined at a p value of less than 0.05. Results: Four hundred and fifty seven medical students participated in the study representing a response rate of 86.7%. The mean age of the students was 25.5±2.9 years and majority (57.1%) were male. A minor proportion of the students (13.6%) were willing to practice in the rural area after graduation. Majority of the students (80.1%) were of the opinion that doctors working in rural area should earn more than their urban counterparts. Factors associated with willingness to practice in rural area included family residence in an urban area (AOR= 0.4, 95% CI: 0.2 – 0.9); work experience before admission into medical school (AOR= 2.0, 95% CI: 1.1- 3.9); intention to specialize in Community Medicine (AOR= 3.1 95% CI: 1.2- 7.7) and satisfaction with rural community posting, (AOR=2.1, 95% CI: 1.2- 3.9). Conclusion: Majority of the students were unwilling to work in rural area after graduation. Knowing the need for doctors in rural practice, a re-orientation of the students on rural practice through adequate community exposure during rural posting is essential. There is also need for increased allowances for doctors working in rural areas and opportunities for training and or further studies should be encouraged.

Providers’ Perception of Quality of Care and Constraints to Delivery of Quality Maternal Health Services in Primary Health Centers of Enugu State, Nigeria.

Aims: The aim of the study was to assess providers’ perception of quality of care and constraints to delivery of quality maternal health services in urban and rural primary health centers of Enugu state, Nigeria. Study Design: This was a qualitative descriptive study. Methodology: A descriptive study design using qualitative data collection and analysis method. Data was collected through a face to face in-depth interview using an interview guide between May and June 2013. A total of 24 providers participated in the study. They included six heads of department of health of six local government areas and officers-in–charge of eighteen primary health centers in urban and rural areas of Enugu state, Nigeria. Results: Most of the providers perceived the quality of maternal health services in the primary health centers as good and they attributed this to results that were achieved. On measures the providers adopted to ensure clients satisfaction, most of the providers in the urban favoured good work attitude while those in the rural relied on provision of incentives. Inability of the health centers to remain open round the clock was identified as the major constraint to the delivery of quality maternal health care in the health centers and this was attributed to the prevailing security challenges in the study area. Other constraints included inadequate number of health workers, poor amenities, and inadequate equipment. Conclusion: The providers in the study area perceived good quality care to be the same as good utilization of services at the health centers. This has made them to adopt client friendly measures like good work attitude and use of incentives to encourage the clients to utilize the health centers. This may invariably lead to good quality care. Also, they view situations that limit access to services at the health centers as constraints to delivery of quality maternal health care. The providers need adequate support from the local government authorities who are the custodians of primary health care in Nigeria and they should also involve the host communities in the discharge of their duties. The primary health centers should be adequately fenced and personnel employed for security purposes as this will improve access primarily and then good quality care. There is also the need to train the health workers specifically on good quality care.